Abortion (Disability)

Andrew Selous Excerpts

Wednesday 9th April 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I thank you, Madam Deputy Speaker, for this opportunity to speak on a sensitive subject. Few would disagree that Britain is a friendlier place for disabled people than it was a few decades ago—better, that is, unless we are talking about a disabled baby in the womb. The contrast between the way we see disabled people before and after birth could barely be starker. A disabled unborn child has effectively no rights up to birth. Many people are shocked to learn that he or she can be aborted right up to birth—as many as 16 weeks beyond the 24-week threshold for able-bodied babies. But the moment after birth, a whole panoply of rights and support suddenly comes into play for the disabled child. I know that from personal experience, and here declare an interest. My own son, Sam, was born with a club foot, one of the defects for which an abortion up to birth can be obtained. Yet within minutes of his birth, the hospital telephoned its specialist in treating club feet, who was on leave at the time and who rushed in within two hours to begin manipulating Sam’s foot.

[Andrew Selous (South West Bedfordshire) (Con)]

On the issue of abortions up to birth, does my hon. Friend share my belief that where the disability may be relatively minor—a cleft palate or something such as that—the public would be very concerned to learn that these were allowed literally right up to birth?

[Fiona Bruce]

Indeed I do, and I thank my hon. Friend for that intervention. Although there are not many such abortions, there are still some taking place for treatable and relatively minor defects, such as a club foot. My son had physiotherapy every day for the first year of his life. He wore a calliper in his early years and he had two operations until into his teens, but now one would never know, unless one was a specialist, that he had been born with a foot defect. Yesterday, Sam was 21, and in the past few days has heard that he has been admitted to Oxford university. It is hard to think that such a treatable disability could have deprived him of life, and he is far from alone. I believe that the footballer, Steven Gerrard, was born with a club foot.

We have allowed a completely inconsistent and contradictory approach to disability to develop in this country with reference to the born and unborn child, and for that reason I am asking the Minister to review the application of this legislation. To clarify, the Abortion Act 1967 was amended in 1990 to provide for abortion up to, and during, birth where there is “substantial risk” of “serious handicap”—often called ground E abortions. But neither of those terms have statutory definitions. Instead, what constitutes “substantial risk” or “serious handicap” is left to doctors to decide, with differing outcomes across the country, and that difference can mean life or death to an unborn child. Professor Gordon Stirrat gives an example of a couple seeking abortion because of a cleft palate at 34 weeks, where there was a significant difference between doctors who refused an abortion under ground E and other doctors who interpreted the law as covering the couple’s situation.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 1st April 2014 Commons Chamber

The Secretary of State was asked—

[Andrew Selous (South West Bedfordshire) (Con)]

1. What steps he is taking to improve compassionate care in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have made it a key priority to restore a culture of compassionate care throughout our NHS. Ten thousand nurses and midwives will have taken part in a new leadership programme that champions patient-focused compassionate care. Pilots are testing whether all nurses should spend time on the wards prior to a nursing degree.

[Andrew Selous]

Will the Secretary of State join me in congratulating NHS staff, who are shifting the priorities of the NHS culture towards compassionate care and away from a tick-box culture? Does he agree with Robert Francis, who says that compassionate care very often saves money?

[Mr Hunt]

My hon. Friend is absolutely right. Last week I was in one of the safest hospitals in the world, Virginia Mason hospital in Seattle, which has cut litigation claims by three quarters since it introduced safer care. We have fantastic hospitals in this country too, such as Salford Royal. The truth is that safer care is better value for money: it means that more money can be spent on the front line, not on litigation.

Adult Autism Strategy

Andrew Selous Excerpts

Wednesday 5th March 2014 Westminster Hall

[Jim Shannon]

I thank the hon. Lady for her valuable contribution. Yes, I agree; I think all hon. and right hon. Members would. Churches have intervened to help in a number of complex cases in my constituency. What is not complex for us is complex for people with autism. There is a clear role to be played in that regard. Only 15% of adults with autism are in full-time employment; again, that results from some of the issues that they suffer from, including epilepsy, sleep disturbance and mental health problems. Many out there are trying to help and assist.

I ought to give a Northern Ireland perspective, because we have done good, helpful work there, health being a devolved matter. The Minister is aware of that good work because he has visited a number of times. Perhaps he might comment on that in his response.

The Northern Ireland Assembly put in place the Autism Act (Northern Ireland) 2011, which is the most comprehensive autism and single disability legislation in the whole of Europe. The need to do something was recognised at an early stage, as was the fact that the power was there to do it within the devolved Administration, and that was done. It is the first legislation in Northern Ireland requiring by law all Departments to plan and work together on the delivery of the strategy. The cross-governmental attitude that the right hon. Member for Chesham and Amersham requested is there. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Stretford and Urmston (Kate Green), who both intervened on me, have confirmed that that should happen. Departments worked together on the delivery of a strategy. No cross-Department barriers are allowed at all. When we say “comprehensive”, we mean it. I am delighted that the debate is calling for such a strategy.

Autism Northern Ireland was at the centre of the campaign for the Autism Act (Northern Ireland) with its grass-roots campaign. There was no money or external lobby company—just hard work, and determination to make it happen and to gain support from all parties, which was forthcoming. It had autism ambassadors—health and education party spokespersons—to build up expertise on issues of concern. It also formed a partnership with Autism Cymru, which was already working with the Welsh Government on implementing a Wales autism strategy. That was the foundation of the Celtic Nations Autism Partnership—Celtic as in “keltic”, and certainly not “seltic”. No offence to any Celtic supporters who might be here, of course. That is a partnership with the autism societies of Scotland and the Republic of Ireland, which has led to initiatives in the USA. The CNAP and Members of the Legislative Assembly visited the US Congress and the European Parliament.

When we say that the approach is comprehensive, we are talking about looking across Europe and the world; examples were considered and discussions took place. That led to the Autism Act (Northern Ireland). A partnership was initiated with Autism-Europe and MEPs to develop a comprehensive and well-thought-out European autism strategy.

In 2012, I highlighted the difference between the Autism Act (Northern Ireland) and the English Autism Act 2009: the Northern Ireland Act is equality-driven and lifelong-focused. Perhaps the Minister will indicate whether the Government are trying to achieve in England the equality and lifelong focus that we have in Northern Ireland through the Autism Act (Northern Ireland) 2011. That Act amends our disability discrimination legislation, too, to include those with social communication disabilities such as autism. That supersedes the Great Britain Equality Acts, which only give recognition and guidance in primary legislation. That is significantly different from how we did it back home, where we have attempted to address adult autism.

I again thank the right hon. Member for Chesham and Amersham for securing the debate. She, like me and everyone else in the Chamber, sees the gaps in the strategy and the need to enhance provision by including an adult strategy. I have raised today the cases of a young girl and a young adult male. The strain on families grows greater with time as the child becomes an adult and more difficult to handle. The legislation should be amended to provide more state help.

[Andrew Selous (South West Bedfordshire) (Con)]

I apologise for not being here earlier, but I was unable to get out of a meeting. One of my constituents contacted me to say that now that her daughter is 20, none of the professionals dealing with her daughter will speak to the mother. Does the hon. Gentleman think that we should make changes, so that with the young person’s permission, if they are over 18 and want their parents involved, all the different organisations work with the parents, who are there for their autistic children as they get older?

[Jim Shannon]

I agree entirely with that most helpful intervention. In my experience as an elected representative, that is exactly what people want. We should help whenever we can. The Minister for Health, Social Services and Public Safety in Northern Ireland has been anxious to collaborate with the Department of Health on what is working well in Northern Ireland. I have great respect for the Minister of State, Department of Health, but perhaps things could work better. There are examples of good work on the mainland. I looked through the background notes this morning before the debate, and one thing that caught my eye is that there is a specialist autism unit at South Devon college called the LODGE—Learning Opportunity for Development and Guided Education—which has been shortlisted at a national award ceremony in recognition of the education it provides to young adults with autism. There are many good examples of how Departments can do better for young adults with autism, and we should be trying to make that happen.

I am keen to assist and work with the right hon. Member for Chesham and Amersham to ensure that adequate legislation is introduced to make changes that will greatly affect the lives of those with autism and their carers. Never forget the carers, who also need support. They love their children, but they need help, because things are not simple. They want their child to have the best future possible, which does not include an institution. How will we deal with ageing parents? I know that I am not the only one who is aware of ageing parents. What will happen to these children and young adults when their parents pass away? They may no longer be able to look after their children and young adults alone. The answer is clear: they need support, and we must put it in place. Hopefully today is a first step towards providing that support to families across the United Kingdom of Great Britain and Northern Ireland. I support the right hon. Lady and her proposal.

Cancer Priorities

Andrew Selous Excerpts

Thursday 13th February 2014 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

It is a privilege to speak in the debate, and I should like to start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on his work chairing the all-party group and on his excellent speech, in which he covered the whole area of cancer care. We are all grateful to him.

I am speaking today in my capacity as the chair of the all-party parliamentary group on brain tumours. I have not held the post for long and, like many MPs, I came to the issue through one of my constituents, an inspirational lady called Nicole Witts. She was diagnosed with a brain tumour many years ago, and she contacted me a few years ago and explained the effect that it had had on her life. She talked about the massive need for increased research funding for brain tumours and asked me to become the patron of her local charity, which raises funds for such research. I gladly agreed to do so, and I have been hugely inspired and impressed by all that she has done. It is she who caused me to become the chair of the APPG and to make this speech today.

I did not know a great deal about brain tumours before I met Nicole, and this has been quite a sharp learning curve for me. Brain tumours are among the very few conditions that are becoming more prevalent than they were a few decades ago. They are much more common now than they were in 1970. Cancer patients are reporting a worse experience in the NHS for brain tumours than for any other cancer. Unfortunately, 58% of men and women diagnosed with a brain cancer die within a year, compared with 5% of people with breast cancer, 35% of people with leukaemia and 7% of people with prostate cancer. There are also considerable regional variations in incidence, ranging from 108 per million in London to 145 per million in the south-west. Brain cancer is the chief cause of cancer deaths in children, in the under-25s and in the under-35s. The consequence of brain tumours striking so young is that the average tumour is responsible for over 20 years of life lost in the average patient, making it the most lethal cancer by that measure.

Let us look at the funding that brain tumour charities receive. I think that Members will be quite surprised by how low it is. The National Cancer Research Institute consistently devotes less than 1% of its research spending to brain tumours. Between 2002 and 2012, the figure was 0.8%, and in 2012 itself the figure was only 0.78%. There was an average of 6.9 deaths among the under-45s for every £1 million spent on research for all cancers as a whole, but the corresponding figure for brain tumours was 82.5 deaths, and more than £7,700 was spent on research for every death from leukaemia, whereas just £1,400 was spent for every death from a brain tumour.

Between 2002 and 2012, breast cancer research received £352 million of funding, leukaemia research received £291 million, prostate cancer research received £149 million, cervical cancer research received £47 million and, right at the bottom, brain tumour research received only £35 million, less than 10% of what breast cancer research received. As hon. Members can appreciate, brain tumour research funding is very much the poor relation. That is a particular problem because, unlike with many other cancers, brain tumour research does not benefit from general research, for a number of clinical reasons: brain tumours are very different from other types of cancer; the blood-brain barrier presents particular difficulties for researchers; and there are more than 120 different types of brain tumour, which makes research much more difficult. The conclusion to draw is that it is only through giving directly to brain tumour charities and funding laboratory-based research that all types of brain tumours—adult, paediatric, low-grade, benign, high-grade and malignant—will be cured.

Let us examine the experience of people living with brain tumours. I am indebted to the Brain Tumour Charity for its report on that just before Christmas, just as I am to Brain Tumour Research for its excellent report last July on the research issue. When we examine people’s experiences of care, we find that we clearly need to make improvements to make sure that they have the best possible quality of life before and after diagnosis. We know that 38% of people living with a brain tumour visited their GP more than five times before being diagnosed. We know that communication between health care professionals, and people living with a brain tumour and their carers, very much needs to be improved. The Brain Tumour Charity has made a number of recommendations in that area: it wants professionals to recognise and respond to the signs and symptoms of brain tumours more quickly; it wants data collected on the quality of care in different areas up and down the country, so that we can see who is doing well and who is not; and it wants to ensure that written information about treatment options is given to people, along with proper signposting to sources of expert help.

I also wish to highlight the importance of clinical nurse specialists, which was mentioned by the hon. Member for Ashton-under-Lyne (David Heyes). We know from the 2013 cancer patient experience survey that there is a huge difference in the quality of care experienced by patients when a clinical nurse specialist is present. When a clinical nurse specialist was present 74% of patients were given easy-to-understand written information about the type of cancer they had, whereas fewer than half of patients—only 49%—received it when no such specialist was present. Some 87% of patients were given a choice of different types of treatment—that is pretty important—with a specialist, whereas only 67% were given it when no such specialist was present. If we look at those patients who were given information about support and self-help groups—a really important area—86% got that with a clinical nurse specialist and only just over half, 51%, when there was not one present.

For those patients who were eligible for free prescriptions, 78% were informed of that when there was a clinical nurse specialist present and only 55% when there was not. Prescriptions are expensive, so that can make a big difference. Similarly, with information on financial help and benefits to which patients might be entitled, 58%, who had a clinical nurse specialist were told what they could claim, and only 25% were told when there was not one present. I think the Minister will agree that those are pretty huge variations in the quality of care. I absolutely agree with what my hon. Friend the Member for Basildon and Billericay said about the importance of early diagnosis.

The final matter I want to raise is the excellent campaign run by HeadSmart, which has produced information cards. I know that the Minister is aware of them. I pay huge tribute to the Brain Tumour Charity and to others who are absolutely determined to get these cards into schools across our country. I have written to every colleague in the House—I hope you got the e-mail as well, Mr Deputy Speaker—telling them about how we can do that, and have provided a sample letter that we can all send to our head teachers. I suggest that colleagues write to their local authorities as well. It is so easy to get these cards. HeadSmart provides them, so local authorities and schools do not have to pay anything. The cards provide the warning symptoms that we need to look out for in pre-school children, children aged five to 11 and young people between the ages of 12 to 18. Symptoms include persistent recurring vomiting, recurrent headaches, balance and co-ordination problems, abnormal eye movements, blurred or double vision, behavioural changes and fits and seizures. They are all on the card, which will fit in a purse or wallet.

My challenge to Members here today and to those who read this debate is to get these cards out to their schools, and to our young people. We know the vast difference that early diagnosis can make; it could literally be the difference between life and death. This is something practical that we can all do as a result of this debate, and I ask all colleagues to try to do it.

Children and Families Bill

Andrew Selous Excerpts

Monday 10th February 2014 Commons Chamber

[Ian Paisley]

Let me take one of the facts raised by Labour tonight. According to tobacco consumption rates in the United Kingdom, 22% of people smoke in the Liverpool district, but according to the statistic put in front of us tonight, 25% of all children are subject to being in front of smokers. The number of people smoking is, therefore, higher than the Government statistics show. We need more clarity on the stats being put about by Members on both sides of the House. Labour and Government Front Benchers should wait, as they said they would in November, for the outcome of the Cyril Chantler independent review. If we wait for the gathering of evidence that we can all accept, we will be in a much stronger position to make the decision we are making tonight.

I am also concerned about the plain packaging measures, which will decimate an industry. There is not sufficient evidence to show that they will do what everyone wants them to do, which is to stop people smoking. A pound store I visited sells boxes for people to put their fags in. It is even possible to get ones that say “Vote Labour” or “Vote Conservative” on them. Believe you me, Mr Deputy Speaker: whenever cigarettes are sold in the future under this provision, these boxes will be given out freely by certain companies because they will take away the one warning that we do know is important, which is that smoking kills. Tonight we are putting in place an opportunity for people to cover cigarettes with no warning whatsoever.

The biggest problem that this country faces on tobacco is the illicit trade: 25% of all cigarettes smoked in the United Kingdom tonight will have been smuggled by criminals. We as a House should do something, on a united basis, to wipe out such criminal empires, instead of making it easy for them by giving them plain cigarette packages that are simpler to print, smuggle and get into the hands of children. That should be our real cause and health concern.

[Andrew Selous (South West Bedfordshire) (Con)]

I rise to support Lords amendment 125 for the very simple reason that children have no choice about getting into a car. Every day, up and down this country, children are told to get into a car by their parents or guardians; they have no choice. I think that we should operate on the basis of the “Do no harm” principle. The facts are clear: 165,000 incidents of childhood disease are caused every year by passive smoking. Not all car journeys are short: a close family member of mine was made to get into a car and to travel many hours to go on holiday while a pipe was smoked in the car. Despite protests, that pipe continued to be smoked.

On enforcement, many laws are not properly enforced—like all hon. Members, I want full enforcement—but is anyone saying that we should abandon the law against driving while holding a mobile to one’s ear because it is not always properly enforced? I have written to my police force to ask how many convictions they have had for people holding a phone to their ear.

Yes, in a perfect world we would change this situation through education, and of course we should refrain from banning things unless we have to, but the fact is that too many children—an estimated 185,000 every day—have to put up with it. Against their will—they have no choice—they are told to get into a small metal unit. We are here to speak up for those who have no voice, which is why I am proud to support the measure tonight.

[Alex Cunningham (Stockton North) (Lab)]

I quote:

“I would ban smoking in cars where children are present. I would do that for the protection of children. I believe in protecting children. I would see it as a child welfare issue.”

Those were precisely my feelings when I introduced the Smoking in Private Vehicles Bill under the ten-minute rule exactly 964 days ago. I did so after a briefing from the British Lung Foundation, with which I have been proud to work ever since. My thoughts have not changed in the two and a half years since, and I am delighted that the day has come when hon. Members have the opportunity for a decisive vote to make life healthier for half a million children. Although I share the sentiment and could hardly have put it better myself, the words I started with are not mine; they date from February this year and are those of the then public health Minister, the hon. Member for Broxtowe (Anna Soubry).

In Committee in the other place, an amendment was tabled and supported by all political parties, with eight peers speaking in favour of the ban. Such is the cross-party nature of the measure. This will be the fourth time that Members of this House have asked for a definitive vote on the issue. After my ten-minute rule Bill failed to get a Second Reading, the noble Lord Ribeiro’s private Member’s Bill won support in the other place but failed to make progress in the Commons. In this Chamber, we tried to amend this Bill, but we failed again. Now, after sustained pressure from a cross-party group of Back Benchers and Lords, four measures are proposed in the Bill—including powers to bring in standardised packaging of cigarettes and to prevent smoking in cars with children present—and I welcome them all.

It is not just parliamentarians who support such a ban—quite the opposite. The changes are backed by many professional bodies and research groups. I have been delighted to work closely with other organisations, as well as the British Lung Foundation. The list is too long to name every person and organisation, but it includes Cancer Research UK, Action on Smoking and Health, the British Medical Association, the British Heart Foundation and Fresh, our own campaigning organisation that has done so much in north-east England. We must not forget the royal colleges and the 700 health professionals, who have already been mentioned.

Facts, figures and statistics in abundance have highlighted the appalling dangers of passive smoking, particularly to children and young people, and specifically in relation to smoking in vehicles. A plethora of studies have returned the same results: smoking in a vehicle significantly increases children’s exposure to harmful toxins and particulates. Numerous surveys and opinion polls have consistently shown that the public support such recommendations. I have no doubt that my fellow Members will draw attention to them as the debate progresses.

I want to focus on the arguments about enforcement and intrusion. It is important to remember that the police already have a number of duties with regard to private vehicles, and to recognise that the additional enforcement costs of a measure to outlaw smoking when children are present are minimal.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 26th November 2013 Commons Chamber

[Jane Ellison]

We are aware of those additional costs, and I know that my hon. Friend recently met my right hon. and noble Friend the Under-Secretary of State for Health. We are very conscious of those costs and of the difficult decisions. It is the subject of ongoing negotiation between the Welsh Government and NHS England.

[Andrew Selous (South West Bedfordshire) (Con)]

12. What lessons he has learnt from the findings of the report of Professor Timothy Briggs on improving the orthopaedic surgery published in September 2012, entitled “Getting it right first time”.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

In 2012 Ministers welcomed the publication of the report and acknowledged that its recommendations could help build on improvements in orthopaedic care. I believe that my right hon. Friend the Secretary of State met Professor Briggs.

NHS England is now responsible for securing high-quality outcomes. Peter Kay, the national clinical director for musculoskeletal services, is also supportive of the report’s findings.

[Andrew Selous]

Growing numbers of orthopaedic consultants accept that collaboration across networks of hospitals could improve the quality of orthopaedic care, which frankly has not always been good enough in the past. Will my hon. Friend accept the recommendations of the “Getting it right first time” report?

[Jane Ellison]

We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

Group B Streptococcus (Newborn Babies)

Andrew Selous Excerpts

Thursday 7th November 2013 Commons Chamber

[Nadine Dorries]

Researchers stated:

“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?

[Nadine Dorries]

I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.

The researchers continued that the sensitivity of such screening was

“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”

Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.

Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?

Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.

Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.

Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.

I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.

Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?

UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?

I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:

“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”

He said to the then Minister:

“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]

My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.

--- Later in debate ---

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

[Andrew Selous]

Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.

Psychological Therapies

Andrew Selous Excerpts

Wednesday 16th October 2013 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

Like my colleagues, I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on bringing this important debate before the House. We know from this morning’s radio bulletins that the discussion is topical and timely, and I am pleased to have the opportunity to contribute to it.

My focus will be on the need to broaden the scope of what is offered under IAPT, particularly in relation to couple relationships. I strongly believe that it is hugely in the interests of the NHS and the Department of Health to realise the significance of strong couple relationships to good health, which is essential to protecting the NHS budget. That point is really important—[Interruption].

[Sir Edward Leigh (in the Chair)]

Order. Officials should not talk to a Member of Parliament while the debate is continuing.

--- Later in debate ---

[Andrew Selous]

As colleagues have already stated, data on the type of therapies available under IAPT show that couple therapy is available in less than a quarter of cases. The data came from the “National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011”, so they are official. The figure for couple therapy is only 24.6%, while interpersonal therapy is available in under half, or 48.3%, of the settings in which provision is made. For psychodynamic and psychoanalytic therapy, the figure is under 40%, at 39.8%, whereas cognitive behavioural therapy is available in 94.9%—just under 95%—of cases.

Those figures demonstrate the significance of CBT, which for some people with mental health issues is absolutely the right treatment, but it is important to realise that CBT is clearly not the appropriate treatment for all those with mental health conditions. We should also remember that all those therapies are approved and recommended by NICE, and the evidence shows that all such treatments are effective for the right patients.

I am particularly concerned that the benefits of a relational approach to the treatment of depression are not being realised and that, in many cases, individual CBT counselling is given where it is not appropriate. I want to tell a true story of one young couple’s experience of interacting with the IAPT programme. Figures and sums of money give the broad picture—they are our stock in trade as Members of Parliament—but they are a bit high-level and do not capture the essence of mental health provision on the front line.

Let me tell the story of Polly and Mark—to protect their anonymity, those are not their real names—who experienced considerable challenges in having two children, with several miscarriages and a stillbirth. Polly became very low and left her successful career. The hon. Member for Feltham and Heston (Seema Malhotra) has already pointed out the cost to the economy when people have mental health issues. Polly’s husband, Mark, had a very difficult childhood, and he was badly affected by his parents’ violent and stormy relationship.

When Polly and Mark’s youngest child was two, Polly confessed that she had had an affair seven years earlier, which left her feeling guilt and shame long after it ended. On learning that, Mark was utterly devastated by the revelation and fell into a deep depression, with unmanageable rages during which he threatened to kill the other man. Polly developed severe headaches, so she went to her GP and was sent for tests. On finding nothing wrong, the GP recommended that Polly have individual counselling focusing on the stillbirth four years previously. After being unable to work and having three weeks of sleepless nights, Mark also visited his GP. Mark was referred to a psychiatrist, who diagnosed him as suffering from acute depression and prescribed him antidepressants.

The couple were acutely conscious that their relationship was about to break down. Not having been offered any form of couple therapy by IAPT, they approached a voluntary sector service, and for six months, they went to weekly couple therapy. At the same time, they were offered cognitive behavioural therapy through IAPT. They believed that the problem was their relationship, but health professionals clearly thought that the depression needed treatment. In couple therapy, Polly was able to share her anxieties about her parents’ divorce and about how she did not want her children to suffer as she had. As the couple therapy progressed, Mark and Polly became more open with each other and began to understand how their relationship problems were a product of both recent and past difficulties.

An important point is that that couple therapy—it was not provided through IAPT; Mark and Polly had to go to the voluntary sector for it, because IAPT had offered them CBT that they did not need—was voluntary help that lasted for six months. My concern is that IAPT provision, whether of CBT or other measures, is often given for only a short period, which is not always appropriate or likely to be successful in such cases.

That true story illustrates powerfully why we need to look again at the IAPT programme, excellent though much of it is, and to take a relational approach to many of the issues where appropriate. I hope that it has been helpful to Members to put that real-life case study on the record.

Academic studies show why what I have said is important and matters. Evidence reveals links between relationship quality, depression and re-employability. For example, a meta-analysis conducted by McKee in 2005 concluded that lack of social support by partners in a relationship has negative impacts on the physical and psychological health of the unemployed person and is especially associated with more frequent development of psychosomatic symptoms, stress and depression.

The all-party parliamentary group on strengthening couple relationships, which I chair, and the newly formed Relationships Alliance published only last week a report that said that relationships were the missing link in public health. That report showed that relationship quality is often a key determinant of health and well-being, and that it has strong links with the ability to deal well with cardiovascular disease, obesity, alcohol misuse and mental health issues. All those issues link up, and strengthening the health of couple relationships is often right at the heart of them.

If we look at what has happened since the IAPT programme began—I understand that it receives funding of about £400 million a year—we can see that the investment has been very much towards cognitive behavioural therapy, with interpersonal psychotherapy, counselling for depression, brief dynamic therapy and couple therapy the poor relations in the area.

In a written parliamentary question, answered on 8 January 2013 and printed in volume 556, column 258, of the Official Report, we learn that of 1,225 sessions in 2012-13 only 99 were for couple therapy, whereas 459 were for CBT low-intensity therapy and 322 for CBT high-intensity therapy. If we look at the period from 2008-09 all the way through to the projections for 2013-14, we will see that of nearly 8,000 different sessions—7,958 to be precise—only 297 were for couple therapy. The story that I have just given of Polly and Mark shows that such sessions are needed up and down are country and can indeed make a significant difference.

[Seema Malhotra]

The hon. Gentleman is making a powerful speech on the importance of having a relational base to services. In my own constituency of Feltham and Heston, I visited a service that was started a year ago by the National Society for the Prevention of Cruelty to Children. It works with children who have parents with drug and alcohol problems. I am struck by what the hon. Gentleman is saying. Is he able to talk a bit more about, or perhaps give a comment on, how having such a focus in a service can help children who are the victim of the illness of their parents?

[Andrew Selous]

I am grateful to the hon. Lady for her comments. May I extend to her a very warm invitation to come to the next meeting of the all-party parliamentary group on 6 November when we will consider such issues further? She is absolutely right that these issues are intergenerational. If she was following the example of Mark and Polly, she would have learned that it was their own parents’ stormy relationships that had affected them. Of course their children were suffering deeply from the problems that they were having in their own relationship or marriage. Such issues are deeply related, and she is completely right to say that the children suffer hugely when there are relationship problems between the parents. It is vital that we get this matter right for the children, and I would welcome her support on a cross-party basis on these important issues; they are just too important to be bipartisan about. I would love to have cross-party agreement on the importance of relational issues in public health, because I feel so passionately about the matter.

Another concern is the geographic differences in the ability to get couple therapy through IAPT at the moment. Ruth Sutherland, the chief executive officer of Relate, told me only yesterday that the programme is very geographically bound. Provision is better in the north of England—I note that there are not many colleagues from the north of England in the Chamber today—than in the south, so there is an inequality of access geographically, as well as there being fewer of these sessions available across the UK as a whole.

Let me make one further point to the Minister about why one part of IAPT provision is an incredibly serious matter for the whole NHS. As a clinician, he will know about the huge importance of long-term conditions, which are faced by so many of our constituents. He will be well aware of the significant demands that they will make on the NHS in years to come. I am talking about strokes and dementia and all sorts of other long-term ailments that many of our constituents will live with for a very long time.

I heard a moving story a couple of weeks ago from a gentleman who was visiting his elderly parents in Manchester. He said that between them as a couple they could function. Between the two of them, they had one pair of eyes, ears and legs that worked. They were both sick in different ways. They could cope and look after each other, but what would have happened if they had split in younger years? They might have been like Polly and Mark and had difficulties and not been able to receive the type of help that I have outlined. Let us say that they did sadly split up, like so many couples do today. They would be in two different flats in different parts of Manchester needing far more help from their GP and far more adult care, and that would fall on the clinicians for whom the Minister is responsible and on adult social services. Yes, it would have an impact on their families, and we would all be paying more through our taxes and there would greater burdens on business as well from having to look after that couple in two different settings. The importance of strong couple relationships in older age, in later life, is critical not least to deal with the increase in long-term conditions, which are becoming more and more prevalent and which many of our constituents will be coping with for many years to come. That is my final pitch to the Minister.

We are talking specifically about mental health and IAPT. I understand that a lot of good work is being done under IAPT and that it is an excellent programme, but I ask the Minister, when he goes back to his Department and talks to his colleagues and the Secretary of State, to take back with him the absolute centrality of strong relational health up and down are country as far as public health, the burdens on the NHS and his Department are concerned.

--- Later in debate ---

[Dr Poulter]

The hon. Gentleman is right. We UK Health Ministers work collaboratively on many issues. However, on veterans, we have to recognise that, although we have UK-wide armed forces, health is a devolved responsibility. We need to share different initiatives better between the devolved Administrations. Some remote areas of Wales, in particular, could learn from best practice in the NHS about how we are using, to good effect, specialist mental health teams for veterans. I should be happy to share that and meet my counterpart in Wales to talk that through in greater detail.

I will focus in particular on the important contribution of my hon. Friend the Member for Halesowen and Rowley Regis. He addressed a number of issues that are central to the provision of good mental health care, and he threw down some challenges on how we could make things better. In particular, he praised the scale of the Government’s ambition to have genuine parity between physical and mental health, which has to be right; it is at the centre of everything that we are looking towards in the good commissioning of services locally.

I reassure the hon. Member for Liverpool, Wavertree that, with the addition of IAPT, there has been a substantial increase in the NHS’s total investment in psychological therapies. As she will be aware, however, it is down to local commissioners to prioritise their resources to meet local need, based on the local population that they serve. In the past, the challenge has been that good commissioning has too often been seen purely through the framework of physical health. Through the NHS Commissioning Board’s mandate, we are now ensuring that there is parity between mental and physical health. That journey is already well under way to ensure that good commissioning is no longer just about commissioning for acute services, such as stroke and heart attack, but about looking at the whole patient and considering the importance of upstream interventions, which are central to IAPT’s role in looking after patients.

My hon. Friend the Member for Halesowen and Rowley Regis also talked about the need to consider CBT and its evidence base. As he knows, it is not the role of Ministers to question the integrity of NICE, but NICE keeps its criteria under review, and there is a very strong evidence base to support CBT. The evidence base for IAPT is continually being developed and adapted, and a number of pilots are already in place to consider the potential to extend the scope of therapies, including to older people. I hope that that is reassuring. NICE will be listening to this debate, and it continues to evaluate the evidence. With mental health, there has always been controversy on how evidence is collated, because mental health is different from physical health, and NICE will keep that under review when it adapts and introduces future guidelines.

The debate has been called because all hon. Members in the room believe that, for too long, there has been too much focus on crisis management and acute response when patients with mental health conditions become very unwell. We would all like to see much more focus on upstream intervention, which is what IAPT is all about. We need to move the focus away from SSRIs—selective serotonin reuptake inhibitors—and drug-based therapy towards upstream, proactive intervention for what is sometimes a very vulnerable patient group.

The benefits of early intervention have been outlined by many hon. Members. There are clear health benefits, but there are also economic benefits, benefits to the family and benefits from getting people back to work, education and training, and from supporting people to have more productive and happier lives. That is why we will continue to ensure parity of esteem in commissioning for physical and mental health, and it is why we will continue to support upstream interventions in the early years—I will address early-years IAPT later. We will also ensure that we continually drive good commissioning to encompass mental health as well as physical health. That holistic approach to health care, by prioritising mental health, is good for people’s health care, good for families and good for the economy. That is why we will ensure that it remains a priority.

As hon. Members will be aware, the mandate set by the Government for NHS England last year establishes a holistic approach as a priority for the whole NHS for the first time. Improving access to psychological therapies is fundamental to the success of improving mental health. The mandate makes it clear that everyone who needs them should have timely access to evidence-based services. That is particularly important for mental health. By the end of March 2015, IAPT services will be available to at least 15% of those who could benefit—an estimated 900,000 people a year. We are also increasing the availability of services to cover children and young people with long-term physical health problems and those with severe mental illness to ensure that everyone can access therapies. There is an emphasis on those who are out of work, the black and minority ethnic populations and older people and their carers.

IAPT is being made available throughout the country. The programme was started by the previous Government in 2008, and we now have an IAPT service in every clinical commissioning group. There are more than 4,000 trained practitioners, and more than 1 million people are entering and completing treatment. Recovery rates have consistently been in excess of 45%, and they are much greater in many areas. The programme already has a clear track record of evidence-based success, and it is helping to reach some of the most disadvantaged and marginalised people in our society, which we would all say is a good thing.

[Andrew Selous]

My hon. Friend is absolutely right about the evidence. Although this is a little premature, he might be aware that the Department for Education has just commissioned evidence on the efficacy and cost-benefits of couple counselling. I have sometimes heard it said that there is no evidence for anything other than CBT, so will he say a little about the range of provision available under IAPT, specifically in relation to couple counselling?

[Dr Poulter]

My hon. Friend is absolutely right. I will address children’s IAPT in a moment, because the hon. Member for Upper Bann (David Simpson) made an important point on that.

My hon. Friend is right that, through not only IAPT but other programmes that consider health care more holistically—particularly the family nurse programme, which is aimed at vulnerable teenage mums—upstream intervention supporting those vulnerable groups helps to keep couples together and helps reduce rates of domestic violence. The programmes also support a stronger bond between mum and baby, so the child does better at school and mum and dad are supported to get back into education, training and work. So it is a win-win situation for the economy, and it helps vulnerable younger parents to have a better start in their own lives and provides a better start in life for their children. That is not exclusive to family nurses; we are also considering how the approach may be developed with IAPT, so that we can have a more joined-up approach both to children’s health generally and to families.

Earlier this year, I launched a system-wide pledge across education, local authorities, the voluntary sector and the NHS to do everything we can to give each and every child the best start in life. Part of the pledge is to do exactly what my hon. Friend outlines, which is to focus on getting early and upstream interventions right to support children in having the best start in life. We are also seeing the benefits of supporting families and reducing rates of domestic violence. I hope that is reassuring, and we will continue to develop and press those policies.

Briefly, our children’s IAPT programme is no less ambitious in its aim to transform services. In 2011, we announced funding for children and young people’s IAPT of £8 million a year for four years, and in 2012, we agreed significant additional investment of up to £22 million over the next three years, which is a total of £54 million up to 2015. That additional funding will be used to extend the range of evidence-based therapies to include systematic family therapies and interpersonal psychotherapy, to extend the range, reach and number of collaborators within the project and to develop interactive e-learning programmes to extend the skills and knowledge of professionals such as teachers, social workers and counsellors. Again, there is a multi-agency approach to improving the support and care available to children, because this is not just about the NHS, but about local authorities and education working together to get it right for young people. Behind those facts and figures are the people whose lives and services have been transformed by IAPT.

To conclude, it might be worth outlining a recent conversation that I had with a GP. When talking about IAPTs in West Sussex, he said, “I hear from GP colleagues that this is the single most positive change to their medical practice in the last 20 years, and I echo this. Our local service reaches out to the community, and it is always looking at ways to improve. It is continually developing new evidence-based interventions for people with anxiety and depression, delivered one-on-one and in groups in a flexible way that means patients have real choice. They have filled a huge gap in need and are a force for good.” That is absolutely right, and it is why we will continue to develop parity between mental and physical health and continue to expand the IAPT programme.

Accident and Emergency Departments

Andrew Selous Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I do not have the figure at my fingertips, but I will happily write to the hon. Gentleman.

[Andrew Selous (South West Bedfordshire) (Con)]

I would like to praise very highly the A and E staff at Luton and Dunstable hospital, whose work I have seen at close quarters on a number of recent occasions. If A and E staff had access to GP records, would there not be better diagnosis and would not time be saved? If some of our smaller hospitals are doing that, it raises the question why all of them are not.

[Mr Hunt]

My hon. Friend is absolutely right. The truth is that many in the NHS had their fingers burnt when the previous Government, with the best of intentions, tried to address the problem, unfortunately with abysmal results and billions of pounds wasted. I do not think that we should let that failure stop us doing what we know can transform services. When we look at the changes that have been made in the banking, airline and retail industries, we see that we need to use the benefits of modern technology in the NHS. It will save thousands of lives.

Brain Tumours in Children

Andrew Selous Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Raab]

I will make a bit more progress, because otherwise the Minister will not have a chance to respond at length, which I know she will want to do.

The HeadSmart campaign has developed an online education module to help health professionals to recognise the signs and symptoms of brain tumours in children and young people. There is now a network of clinical champions in each of the neuro-oncology centres around the UK giving presentations to fellow health professionals on the subject. There is also, critically, a network of local champions. David’s mum, Sacha, who is also here for the debate, is the first of those.

HeadSmart awareness packs have been distributed to more than 1,000 doctors’ surgeries around the country, and more than 625,000 symptom cards have been distributed across the UK. Only one year after the launch of the HeadSmart campaign, the diagnosis delay has fallen from an average of 9.3 weeks in 2011 to 7.5 weeks in 2012. This year, it is down further to 6.9 weeks. That is terrific progress, and we should welcome it.

[Andrew Selous (South West Bedfordshire) (Con)]

Will my hon. Friend give way?

[Mr Raab]

I am just going to make a bit more progress, if I may, but I will come back to the hon. Gentleman. The progress has been good, but it has also highlighted how easy it is, with practical steps, to save lives and prevent the serious and permanent damage that tumours can inflict on their survivors. HeadSmart’s explicit aim is to get the average diagnosis delay down to five weeks, which represents best practice in the west. That would save countless lives and reduce the number of permanent disabilities.

There are various aspects to the ongoing campaign, and hon. Members have intervened already with particular dimensions that they want to explore. I want to focus on three basic steps, which are well within our gift as politicians, to help us reach that critical five-week target. The crux of the debate, compared with so many others that we grapple with, is that that target is reachable and these three measures are in the “eminently doable” category. We really ought to stretch our sinews as politicians to ensure that the target is reached.

First, and most importantly, the HeadSmart campaign has made it a priority to get its credit card-sized awareness cards into every school and nursery in the country, as my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) has mentioned. I have got one here. It can fit into the smallest wallet or purse; it explains the early symptoms of a brain tumour; it differentiates between symptoms depending on the age of the child; it tells you what to do if you are worried; and it gives contact details and a website to find out more information. If the cards are handed out to children at school to take home to their parents, that will go a long way towards heightening awareness and ensuring that children and parents have an easy reference tool to hand.

HeadSmart is already making progress. As we have heard, distribution has been carried out in Wiltshire, East Sussex, Sutton and Reading. Those areas are the trailblazers, and other councils are expected to follow their lead soon. I will be visiting Surrey county council with Sacha tomorrow. To date, the campaign has benefited from local co-ordinators who make contact with councils to encourage them to disseminate the cards through their internal mail system. Critically, because the Brain Tumour Charity pays for the cards and bundles them for distribution, the measure costs the councils nothing.

What we need now from Government is co-ordination and, frankly, political will, rather than pounds and pence. I have a very simple request, which is the most important purpose of the debate. Will the Minister write to every head of public health in all our councils, given their new responsibilities in the area, and urge them to back the campaign by sending out these cards for distribution via every school and nursery? That is the single measure that can contribute the most towards nailing the five-week target.

[Andrew Selous]

Brain tumours are the main cause of cancer deaths in children. Does my hon. Friend share my concern that they get only 0.8% of research funding, given that they are so significant?

[Mr Raab]

Although I am focusing on three practical aspects of the campaign, I thank my hon. Friend for that wider point about research funding. It was well made and I am sure that it has been registered.

The second key measure under the HeadSmart campaign is for the Government to encourage secondary school head teachers to invite the Teenage Cancer Trust to do a one-hour talk on the subject, because that has a proven track record of spreading awareness. Will the Minister take the lead and team up with her colleagues at the Department for Education to deliver on that important step?

--- Later in debate ---

[Andrew Selous]

As my hon. Friend the Member for Esher and Walton (Mr Raab) has said, local authorities are already writing to schools and putting stuff in the post. If MPs do that too, it will cost the public purse. It strikes me that that already happens, and cheaply.

[Anna Soubry]

I do not agree. I do not know about my hon. Friend, but I write to all my schools. In truth, I do not have that many schools, so there are not that many letters. A letter from a Member of Parliament to all their schools and to their health and wellbeing board could be very powerful. I am more than happy to talk to my colleagues in the Department for Education, but I am not sure that a letter to cabinet members will have any weight.