Independent Medicines and Medical Devices Safety Review

Ben Spencer Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

I could not agree with the hon. Lady more. As I said earlier, whether it is Shipman, Paterson, Cumberlege or a maternity incident, women so often struggle to get their voices heard when they are at the heart of issues like this. I would be happy to talk to the all-party group, particularly on sodium valproate, where a huge amount of work is being done. We are seeing the number of users of sodium valproate in pregnancy declining, but there is more work to be done. I would be particularly interested in talking to the hon. Lady about how we get the message out about the dangers of sodium valproate, because there are women who suffer from epilepsy for whom sodium valproate is the only treatment that works effectively. That is the heart of the problem that we need to keep discussing and work through further. I am happy to meet and talk to her.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

The NHS collects a wealth of data in different clinical settings, but often computers and systems do not talk to one another; they are silent. What is on a GP’s computer may not be on a hospital computer or a health visitor’s computer, and this report highlights the critical need for registries and data that are systematically collected. Can the Minister assure me that another registry or dataset will not end up isolated and silenced, as many of the victims were before this report?

[Ms Dorries]

I thank my hon. Friend for that point. I had a thought while I was listening to him, which is that I did not mention Sir Cyril Chantler in my statement, the doctor who contributed hugely to the report, along with Baroness Cumberlege. I thank both of them. They worked as a team—even though it is the Cumberlege report, they worked together, and Sir Cyril deserves recognition and thanks for his work.

I agree with my hon. Friend. Because of the many reports a number of regulatory bodies have been established, but it is in their talking to each other and the bridges between them that we have problems. We recognise that this is a complex area. However, we have already gone beyond the development of the database. The Medicines and Medical Devices Bill was amended in the House, with cross-party support, to create a power to establish a medical devices information system. That will respond to Baroness Cumberlege’s recommendations in full, including ensuring that private providers that do not operate under the NHS contract can be required to provide data to that information system. NHS Digital is leading work with system partners and the devolved Administrations to ensure that this comprehensive database can be used to support clinicians and the MHRA. My hon. Friend is right to say that in the development of the database, all the organisations and regulatory bodies need to work together and support one another.

Testing of NHS and Social Care Staff

Ben Spencer Excerpts

Wednesday 24th June 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

First, I wish to pay tribute to the work of all our NHS and care staff in Runnymede and Weybridge—thank you. The pandemic has affected us all and the response to it has been from all quarters. NHS leaders such as the NHS Confederation have said that we need “Reset, not just recovery”. The response to this pandemic gives us a once-in-a-lifetime opportunity to build back better.

This motion invites us to look to at the future, but in doing so we need to look at the big picture. The lockdown has had a huge impact on lives and livelihoods; it has damaged our economy. The health of our nation is its economy. People often speak about health and the economy as separate issues, but they are not. Be in no doubt: poverty is just as deadly as any coronavirus, but its effects can be slow and silent. Almost every disease is highly associated with poverty and socioeconomic deprivation—I am talking about diabetes, cancer, high blood pressure, strokes, mental illness, and drug and alcohol addiction—with early childhood experiences laying down health risks that play out over a lifetime. As the economy suffers with lack of opportunities and jobs, poverty and socioeconomic deprivation worsen, and, as a result, so does the health of the nation—it just takes much longer to see the effect.

However, that future is by no means inevitable and to avoid it we must reset, not merely recover. Today we need an immense public health response to prevent the illnesses that are caused by this crisis but which will be detected only in years to come. Our response must come from all quarters of government, impacting all society. A few examples are cutting air pollution from our aeroplanes and motorways such as the M25, preventing lung diseases and protecting our planet; protecting green space so that people can exercise, and reduce and prevent childhood and adult obesity; and early interventions in schools preventing adult mental illness. The best example I can give of joined-up working is meals on wheels—a lifeline to many but also preventing malnutrition and illness in older people. You see, adult social care and related support is a public health measure. This is an area that we must take forward and fix.

None of the areas I have mentioned fall directly under the NHS, but all have a profound public health impact on disease, and ultimately a profound impact on the care the NHS needs to offer. We cannot look at the issue of healthcare as we do today and limit it to the NHS. We have to see healthcare as embedded in all our communities and linked to all our other policies as diverse as infrastructure, education and local planning. Only through this can we meet the challenges that healthcare faces, and not purely the challenges that we face from covid. As we reset and restart the NHS, now is the time to unleash it—to unleash healthcare—from its silo.

Covid-19: BAME Communities

Ben Spencer Excerpts

Thursday 18th June 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I thank the hon. Member for Brent Central (Dawn Butler) for securing this debate and the Members who have made such powerful and thoughtful speeches throughout the debate. I wish to focus on the PHE report and, as it is a theme that has emerged from this debate, a call for action.

The recent PHE report on the disparities in risk and outcomes of covid found that being from a black and minority ethnic background is associated with a significantly increased risk of death from covid. That is a deeply concerning and worrying finding. The researchers were able to control for the effects of age, sex, socioeconomic deprivation and, to a limited extent, occupation, as all those things are increasingly understood as risk factors for death from covid. However, it remains unclear whether the effect of ethnicity is in part mitigated by obesity or other health conditions, such as diabetes or high blood pressure, which are known to be more prevalent in the BME community. That is a health inequality in and of itself, but the study was unable to control for it. It was also unable to provide a detailed and granular understanding of the effect of occupation, especially for those working in public-facing or care roles. The report further concludes that research needs to be done in this area. It is absolutely right that the Government are urgently looking into this. By getting detailed scientific data, we can understand better the complicated relationships between these factors and not only shape our respond to covid, but continue to inform future health policy to address the needs of those who are currently being left behind. We have to do that very quickly.

The PHE stakeholder report makes several recommendations for change, which Members have mentioned. The one I wish to highlight in this debate is the need to accelerate efforts to target culturally competent health promotion and disease prevention programmes, as the importance of that cannot be overstated. Broad-brush approaches to interventions may work for the majority, but they can miss out some of the people most in need, and we need to ensure that our public health programme has the right message, at the right time, delivered in the right way, for the individual to exert change.

Many people still face health inequalities in the UK. I have already mentioned socioeconomic deprivation, an important driver of those inequalities that I wish to discuss a little further. Socioeconomic deprivation is a factor in almost all acquired health conditions. I am sure that that is on our minds at this moment, given the possible long-term impacts of the lockdown. We must ensure that everyone has the same opportunities in life, which means tackling inequalities, socioeconomic deprivation and all the factors that drive it, with access to quality education being key.

The coronavirus pandemic is a pandemic of inequalities that hits those who are already worst off the hardest. This Government, and the one before it, have worked hard to tackle health inequalities in the black and minority ethnic communities. For example, one aim of the independent review of the Mental Health Act 1983 was to examine and change the increased likelihood of people from a black and minority ethnic background being detained under that Act. As a mental health doctor, I took part in that review and sat on one of the working groups. That work was to help shape a White Paper and reform our mental health laws for the future. It is now time for us to publish that White Paper and drive forward those much-needed reforms.

This pandemic is likely to have a grave impact on those struggling with mental illness in society, and while I do not know this, I worry that that will disproportionately impact the black and minority ethnic community. Now more than ever is the time for definitive action. We need a public health revolution to tackle the burning injustice of health inequalities in the black and minority ethnic community. We must ensure that the pandemic does not end up entrenching inequality, and the way to do that is to move public health from the margins to the centre of our national health strategy.

Covid-19 Response

Ben Spencer Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

Ensuring that we get these statistics accurate is incredibly important. We are working on that with the UK Statistics Authority. It is a big piece of the work to ensure that we get the publications right.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I welcome my right hon. Friend’s announcement about his focus on the vital research into the risk factors of serious illness from covid, especially the impacts of age, sex and ethnicity. I look forward to future research that takes into account comorbidities, which are a crucial part of the puzzle. Does my right hon. Friend agree that we are now reaping the benefits of long-term investment in research in the NHS so that we can do these studies, but in going forward and understanding better the impact of comorbidities, can he give me an idea of when that may report back so that we can make policy decisions based on it?

[Matt Hancock]

This is clearly urgent work to disentangle the different factors that cause the disparities evident in the data in the report published today. The Equalities Minister will be leading that work, working with Public Health England and others, to get to the bottom of that as quickly as possible.

Lesbian, Bisexual and Trans Women’s Health Inequalities

Ben Spencer Excerpts

Tuesday 10th March 2020 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I thank Members across the House for some very powerful speeches. It is always an invidious task to single out individual ones, but the hon. Member for Livingston (Hannah Bardell) spoke very powerfully when she opened the debate.

I have a declaration of interests of sorts to make. Before being elected to this place, I worked as an NHS doctor specialising in mental health. For almost eight months or so, I was an in-patient consultant looking after women with psychiatric problems and I looked after quite a few bisexual, trans and lesbian women. I went on to work as an HIV mental health specialist in south-east London, where, as Members will understand, these issues are relevant.

Today’s debate highlights the importance of understanding and addressing health inequalities wherever they are. We must ensure that everyone has access to great opportunities, with a safety net when things do not go to plan. The health service and our public services in general are a key part of that. That means breaking down barriers to accessing those opportunities and services. I wish to focus a bit today on stigma, research and tailored services.

As we have heard today, LGBT health inequalities need to be addressed, but to do so we first need to understand why they exist. This debate focuses specifically on lesbian, bisexual and trans women’s health inequalities, raising an important and often overlooked point about the LGBT community: the assumption that the LGBT community is one community with one set of needs. If we are to address inequalities, we must also understand complexity. We must tailor our services to support and reflect the communities in which we live. For example, many black, Asian and minority ethnic women face different cultural pressures from those of white Europeans, which can affect their ability or willingness to access services. With regard to the LGBT community, we must recognise “the minorities within the minority”.

On the recent report by the all-party group on HIV/AIDS, I am in a rather unusual position: I was a witness providing evidence for the report when I worked as a doctor and I went on to become an officer of the group, after I was elected. I do not know whether I am the first, but I would be interested to hear whether other people have had similar experiences in engaging with all-party groups. The report found that a key contributor to inequality is the stigma that many people still face.

Stigma ruins lives. Many communities still view sexual orientation and gender identity issues as shameful or dishonourable. More than 70 jurisdictions around the world still criminalise same-sex consensual relationships and fear of these views can prevent those who need help and support from seeking it. Those suffering from mental health problems also face stigma. When these issues overlap, people can feel increasingly marginalised and isolated. The point about intersectionality was well made by the hon. Member for Livingston. It is a crucial issue.

Mental health issues, in particular, disproportionately affect people who are more vulnerable, marginalised and suffer from socioeconomic deprivation, including LGBT communities. Although health inequalities among the LGBT community are well documented, they are not well researched or understood, especially the intersectionality element of that, which, as I say, is a huge issue. This lack of data perpetuates stereotypes. A good point was made about NHS stereotypes. The service that I used to work for submitted to the all-party group on HIV/AIDS concerns about anecdotal stories of NHS workers having awful stereotypes about people accessing their services. That is an area where we need to seek out, educate and transform. It is sad that that still exists.

Most of the research that does exist in this area is on men’s health and it is predominantly focused on HIV and sexual health. Sexual inequality debates usually focus on sexual health and wellbeing, overlooking inequalities such as access to mental health services, drug and alcohol services and the like. For lesbian, bisexual and trans women, there is even less awareness and understanding. Inequalities for these women include pregnancy and reproductive health issues: for example, they are more likely to miss cervical screening, as has already been mentioned.

In order to fully understand LGBT health inequalities, we need more detailed clinical research and data. With improved understanding must also come improved tailoring of services. Multiple complicated issues, such as those experienced by the LGBT community, are often exacerbated by a lack of integrated care. Research published by Stonewall in 2018 found that 52% of LGBT people experienced depression. For lesbian, bisexual and trans women struggling with reproductive issues, the challenge is accessing both physical and mental health services in a clear and co-ordinated way.

The move towards sustainability and transformation partnerships in the NHS in 2015 was a step in the right direction. It is now vital that these partnerships develop into integrated care systems to deliver on the Government’s NHS long-term plan. I congratulate the 14 areas in England that have already become—or are near to becoming—integrated care systems, including Surrey Heartlands health and care partnership, which looks after my constituency of Runnymede and Weybridge. However, I urge the Government to ensure that all sustainability and transformation partnerships meet the April 2021 deadline to become integrated care systems, so that all our residents can benefit from integrated services that operate in the community and are tailored for the communities they serve. These changes are an opportunity to break down barriers, and to provide a comprehensive, inclusive and co-operative approach to the services we deliver.

Only by engaging and learning from our communities can we understand the inequalities that they face. Only by ensuring fully integrated health services can we address the inequalities affecting minorities such as lesbian, bisexual and trans women. Only by addressing those inequalities can we ensure that everyone has equal access to the support services and opportunities they need.