Eating Disorders: Provision of Care

Baroness Brinton Excerpts

Tuesday 4th February 2020 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I too offer my thanks to my noble friend Lady Parminter for securing this important debate. For many years, this has been an invisible disease without enough resources to ensure that those who present to doctors get the vital support that they need immediately. I pay tribute to my noble friend for her tireless work on eating disorders, based on her own family’s experience. I also pay tribute to my noble friend Lady Janke for speaking of her family experience. My noble friend Lady Parminter talked about the lived experience of sufferers who are champions but my noble friends both showed, through their contributions, the effort it takes to hold a family together while supporting a child going through this terrible disease. I remember a friend of mine disappearing from school some 50 years ago at the age of 14 and never returning to mainstream school. Until I met her sister, some 30 years later, we never knew that she had had anorexia. It was not spoken about and there was hardly any treatment at all.

It is important to recognise that support and treatment have improved substantially in recent years, including the extra £30 million for young people with eating disorders, but it is clear from this debate that the context of resources is vital. Clinical approaches to eating disorders have changed, but the number of patients and the support they need is at crisis point. We have heard that in 2018-19 there were more than 19,000 patients admitted to hospital with eating disorders but only 649 beds in England. That is an astonishing two patients per hour per day, yet we know that resources are so scarce that patients are now routinely turned away for not being sick enough.

The noble Baroness, Lady Murphy, spoke about Hannah on “Woman’s Hour” today. I suspect it was the same Hannah whom the Sunday Times talked to last Sunday; she was turned away from the Greater Manchester Mental Health NHS Foundation Trust because she was not ill enough and her BMI had not dropped to the point at which it would automatically guarantee entrance, even though in her experience of the disease there was evidence that she was deteriorating rapidly. She is very brave in speaking up. We need to know the reality of what is happening. I am afraid that one of the reasons for this—other noble Lords have been discreet, but I will not be—is that clinicians are having to ration support for eating disorders. The parity of esteem enshrined in legislation under the coalition is still a pipe dream.

A further problem is touched on in some of the helpful briefing we have had, including that from the GMC and the Library: the transition of young people from CAMHS to adult services. In my family’s experience of CAMHS—everyone should recognise that there is usually some experience of mental health services—the transition period was a complete nightmare, even though we got an extra year after the age of 18 to transition through. The attitude and approach were completely different and led to a crisis within a year. That problem of transition, which has been recognised and understood in education and children’s services for the most vulnerable young people who are looked after or have learning disabilities, also needs to be applied to children with mental health problems, particularly those with eating disorders since we know that this disease targets those aged between 15 and 25. To suddenly change everything at 18 is an extremely traumatic experience for the young people and their families. What plans are there to extend access to children and young people’s mental health services up to the age of 25, obviously transitioning as is best for the individual concerned?

While the Government discuss abolishing the four-hour accident and emergency targets overall, what plans are there to introduce waiting time targets for adults as well as children in accessing mental health services, and specifically for eating disorders? Currently only a third of young people with diagnosable conditions get NHS treatment without long delays. Liberal Democrats believe that we should ensure that 50% of children and young people with diagnosable conditions should have treatment by the end of this year, improving to 100% by 2025. Currently, only four in 10 adults get access to treatment. We believe that seven in 10 adults should get access to treatment by 2022. We must set an ambition that everyone who needs treatment gets it by 2025. That will be the point at which we can believe that we have parity of esteem in mental health services.

Other noble Lords have spoken about the importance of early diagnosis. Currently, medical students receive on average less than two hours’ teaching on eating disorders throughout their undergraduate training. By improving training, we will be able greatly to improve early intervention, especially for those on the front line—GPs and more general physicians. Other noble Lords, including the noble Baroness, Lady Hollins, have spoken with experience and expertise on this.

There are other workforce issues. The helpful briefing from the GMC pointed out that there are only 70 posts, mainly in CAMHS, of which a substantial number are vacant. Both the noble Baroness, Lady Hollins, and the noble Lord, Lord Brooke, talked about the practicalities of gaps in the rota, which inevitably impact on patient care. How on earth can you attract young medics to psychiatry if candidates know that resources are not just scarce but will rely on them turning away those patients they know need urgent intervention?

The noble Lord, Lord Lexden, spoke about the importance of educating school staff in recognising the difficulties that some young people face and in helping to signpost them to their families to get help. I too pay tribute to Beat and other charities that provide that expertise to those who can help. However, above all, it is the patients and their families who need help and support. We are overcoming the burden of secrecy in eating disorders, which is good, and the voice of Hannah and many others who have a lived experience of eating disorders is vital. However, we also have a duty to provide the resources for beds, access to clinics, staff and support staff to help people overcome this disease. None of that can happen without money. Therefore, my final question to the Minister is to ask about the increase of funding for adult services and treatment of eating disorders more generally in this area over the next five years.

Coronavirus

Baroness Brinton Excerpts

Monday 3rd February 2020 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for repeating the Statement and once again pay tribute to the medical, public health and NHS staff who are working so hard to deal with this crisis, both in the UK and internationally. Last week, the Minister underlined the importance of all public health authorities and the NHS working closely together to ensure clear co-ordination. Now that the World Health Organization has declared the virus a public health emergency of international concern, this is more important than ever.

As we have heard, 93 British nationals have now been repatriated to the UK and transferred to a dedicated NHS facility in the Wirral as a precautionary measure. Can the Minister update us on the health and well-being of those people in quarantine? There have also been reports that 15 health workers have been diagnosed in China. We know that the virus mainly spreads through contact with an infected person. Can the Minister outline what protections are in place for health workers, particularly for those in the Wirral and in Newcastle, who are in close contact with those in incubation?

One of the disturbing findings from the early stages of the virus so far has been reports that a number of the people who have sadly died had pre-existing conditions. Does the Minister have any further information on this, including on the particular types of pre-existing conditions and what steps will be taken here to advise and support these very vulnerable people in the UK?

On vaccine development, there have been suggestions that human trials of a vaccine could start soon and be progressed with unprecedented speed. I welcome the reference to this in the Statement. The Times today reports that the head of the Coalition for Epidemic Preparedness Innovations has mentioned that an investigational vaccine from gene sequencing of the pathogen through to clinical testing could happen in 16 weeks, with the earliest stages of clinical trials taking two to four months. We welcome the Government’s £20 million contribution to the coalition’s research to speed up development of a vaccine. Has the Minister any specific further information on how quickly they expect the vaccine to be available and ready to distribute?

The Minister will be aware that many east Asian people living in the UK have reported being the target of racist abuse linked to the outbreak, while Chinese businesses are suffering from bogus claims that Chinese culture is to blame for the coronavirus. Their community leaders have expressed concern about repercussions, as Chinese students, workers and tourists in Europe become a focus of fear and confusion about the virus. What steps are the Government taking to combat racism, stereotyping and making assumptions during the outbreak of the virus?

Finally, we fully support the Government’s public information campaign centred on simple preventive measures to minimise the risk of the virus spreading, such as by washing hands and using tissues when you sneeze. Can the Minister reassure the House that the campaign will be proportionate to the risk currently faced by the general UK population? While we need to alert the public, we all want to avoid causing unnecessary stress or creating a panic.

[Baroness Brinton (LD)]

I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.

Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that

“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”

It also says:

“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.


It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?

Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their comments and very relevant questions. The UK is of course very well prepared for these types of outbreaks. We have responded extremely well on previous occasions, so we should have confidence not only in the capability of Public Health England and the NHS to respond, but in the ability of our chief medical officers to assess the level of risk, which speaks to the point the noble Baroness, Lady Brinton, made about the pace and types of responses being put in place. This is clear medical advice based on the evidence and data available.

The advice available for travellers is obviously being kept under constant review and it has changed. Currently, there is advice against all travel to Hubei province and all but essential travel to mainland China. Essential monitoring has been put in place for all incoming flights from Hubei province, and for wider travel too. Public health officials are meeting all those flights and advice is being given as outlined in the Statement.

Rightly, a question was raised about the risk to the health workers who respond, as this is a virus that is spread by contact. Obviously, this speaks to the capabilities of NHS expert teams, who are accustomed to responding to any risk. As well as the expertise they already have, advice is being communicated from the CMO and others. The NHS expert teams are with every ambulance service and are in a number of specialist hospital units, where equipment and highly trained staff are ready to receive and care for patients with any highly infectious diseases. We have also provided an extra service on NHS 111, for public health advisers to triage people with specific queries or symptoms who have travelled from the region, so that they get to the right point. I hope that answers the question.

On the question of information to NHS staff across the system, a tripartite letter has been issued by the CMO, the NHS medical director and the director for the National Infection Service and PHE to all front-line clinical staff, so that they are aware how to respond and what steps to take when encountering patients arrived from overseas with respiratory infections. This was updated on 31 January in the light of the WHO’s declaration of PHEIC. I think we can be reassured on that point.

It is absolutely right that the evidence shows that the mortality rate of between 2% and 3% is mostly for older patients and those with pre-existing conditions. That is part of the data and the evidence which has been given to the NHS so that it knows how to provide appropriate care.

I would like to respond to the questions raised regarding the care provided for the confirmed cases. Public Health England is making good progress in identifying and contacting anyone who has been in close contact with those two confirmed cases. Thorough investigations will continue, to ensure that we take all possible actions to identify anyone who has come into close contact with them. They will be given health advice about symptoms, and emergency contact details to use if they become unwell within the 14 days. This is based on the CMO’s advice about tried and tested methods. Additionally, we are pursuing wider contact tracing across the country for all who have come in from Wuhan. We are confident in the progress that we are making.

Finally, I turn to the questions regarding vaccines. As I noted in the Statement, the Government have pledged £20 million to develop new vaccines to help to combat the world’s deadliest diseases. This will support work developing new vaccines for epidemics and includes three new programmes to develop vaccines against novel coronavirus. The project aims to advance vaccine candidates into clinical testing as quickly as possible. I cannot give an exact timeline to the noble Baroness today, but I shall endeavour to get her as much information as possible. I am sure that we shall have more discussion on these issues as we go through this, but I hope that I have answered her main questions. If I have missed anything, I will be very happy to write.

Nursing and Midwifery

Baroness Brinton Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

Yes, indeed. As the noble Baroness will know, Florence Nightingale was perhaps one of the earliest and most notable statisticians. She is a great role model for those young women who wish to go into STEM careers. One way in which we wish to mark this bicentenary is with the Nightingale Challenge, which calls for every employer of nurses globally to provide leadership and development training for young nurses and midwives in 2020. The aim is to have at least 20,000 nurses benefiting from it in 2020, with at least 100 employers taking part.

[Baroness Brinton (LD)]

My Lords, it is right that we have congratulated nurses and celebrate them but it is also the year of the midwife. It is important that we celebrate the progression in midwifery. Midwives are often much less publicised for the work they do within the community. What plans are there for celebrating midwifery specifically during this year?

[Baroness Blackwood of North Oxford]

We are of course conscious that we need to support midwives, especially as we look to raise standards in midwifery. Specific plans are being developed by the Chief Nursing Officer, Ruth May, which will ensure that all parts of the nursing profession, including midwives, will be focused on. These will be brought forward shortly.

Wuhan Novel Coronavirus: UK Citizens

Baroness Brinton Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

Public Health England is doing a superb job in providing very clear advice for all those who may be concerned—either those who have relatives in China or those who feel as though they have been exposed. I encourage anybody with concerns to look to Public Health England for the most accurate and up-to-date advice; it is updated on a very regular basis. That is the place to go for the most accurate and clinically validated advice.

[Baroness Brinton (LD)]

My Lords, the Question from the noble Viscount, Lord Waverley, asked about British citizens returning from China and other affected areas. The Minister has concentrated her replies on Wuhan and Hubei province. Yesterday, Dr Michael Ryan, the executive director of the World Health Organization Health Emergencies Programme, said:

“The whole world needs to be on alert now, the whole world needs to take action and be ready for any cases that come, either from the original epicentre or from other epicentres that become established.”


What advice is being given to people coming from other countries where there are already reported cases?

Wuhan Novel Coronavirus: Threat to UK Citizens

Baroness Brinton Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important and timely Question. I am happy to update the House that, from today, enhanced monitoring is in place for all direct flights from Wuhan to the UK. Public health officials will meet every direct flight from Wuhan to the UK and will be on hand to provide information about symptoms. Mandarin and Cantonese speakers will be on hand and leaflets will be available in several languages. We will also roll out enhanced monitoring of all flights arriving in the UK from China. Leaflets and information will be available across all UK airports, advising travellers from China on what to do if they feel unwell. The enhanced monitoring of direct flights will obviously be kept under continuous review and expanded if necessary. The risk to the public is low and the NHS is well prepared but, to answer the noble Lord, any patients assessed for this new disease would be isolated under standard procedures if necessary. There are a number of infectious disease units around the country that would be able to respond appropriately.

[Baroness Brinton (LD)]

My Lords, it is good that the Chinese Government, and indeed our Government, are responding better than has perhaps happened in some past incidents, including over SARS. The BBC has reported today that a number of Chinese cities are now reporting that there are people with this condition. When will flights from those cities, and not just Wuhan, be monitored? Also, will there be specific traveller advice for UK citizens travelling into China who have chronic and underlying conditions that mean they may need to take more care?

NHS: A&E Waiting Time Target

Baroness Brinton Excerpts

Tuesday 21st January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, I know that the timetables are going to come forward in the people plan, so I cannot give you that in detail today. What I can tell you is that we have announced that we are investing an extra £4.5 billion in primary and community care by 2024 to fund a good amount of this. The five-year GP contract was agreed between NHS England and the BMA last January, which makes the job much more attractive. In addition, salaried GPs will receive at least a 2% increase and there are incentives to attract them into rural areas, which are struggling the most with recruitment. We have also announced that we want to recruit staff into support services around GPs so that GPs are not focusing on administrative tasks, which has been a disincentive to recruitment over the last period.

[Baroness Brinton (LD)]

My Lords, in addition to the importance of having more GPs to help relieve pressure on the service, there is still the continuing problem of social care, where many people are ending up in A&E or being returned to hospital after a brief stay back at home, or in a home. When will the Government publish their review on social care? We need to make sure that social care is absolutely understood and refunded properly in the future.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is right to hold the Government’s feet to the fire on this issue. I know the strength of feeling in the House on this matter. She will know that we have provided councils with an additional £1.5 billion to make sure there is short-term funding to address the challenges. Also, of course, the better care fund has provided some winter funding to address some of the challenges. But she is right that there needs to be sustainable funding for the long term. We look forward to the SR for that. Regarding the long-term solution, the Prime Minister has been clear that he wants to bring that forward within this year.

Young Carers: Health and Well-being

Baroness Brinton Excerpts

Monday 13th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

We have now delivered all 12 of the commitments and recommendations in the Carers Action Plan to improve the situation for young carers, but the noble Baroness is absolutely right that the way we will improve on that is by improving identification. As I have said, with support from the Carers Trust and the Children’s Society, we are focusing on making sure that we embed not only early identification but also the right support throughout our work with young carers. We know that we have further to go but we are determined to do so.

[Baroness Brinton (LD)]

My Lords, the Children and Families Act 2014 made a very clear link between the Department for Health and Social Care working with other government departments to ensure that young carers got support, specifically the Department for Education. Also in that Act is a young carer’s assessment that every young carer is entitled to. What are the Government doing to ensure that every school identifies such young carers and makes sure that a referral is made to other support mechanisms elsewhere, including health?