Covid-19: BAME Communities

Caroline Nokes Excerpts

Thursday 18th June 2020 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

I congratulate the hon. Member for Brent Central (Dawn Butler) on having secured this important and timely debate. She picked up on several themes that I will probably echo, but she also spoke about voices, focusing on Marcus Rashford and Raheem Sterling—people who have used their voices effectively. In my speech, I will concentrate on the voices of BAME workers in our health service.

At the very start of the pandemic, we had a debate in this Chamber about the emergency covid legislation. I vividly remember receiving a briefing from the Equalities and Human Rights Commission that spoke about how the pandemic might affect different groups of people differently. It is interesting to read and review that briefing with 2020 hindsight. When it spoke of BAME communities, it mentioned their employment opportunities, including the likelihood that young BAME people in particular would be working in unsecure employment in the gig economy and on zero-hours contracts. What it did not speak about was their health.

I think that the death toll has shocked us all. But it is not only the death toll, is it? As the hon. Member for Brent Central highlighted, BAME people are more likely to be hospitalised. If hospitalised, they are more likely to end up in intensive care units. And if in intensive care units, they will be there for longer. As we have learnt over the course of the pandemic, all those things have a significant impact on people’s wellbeing going forward because the longer that someone is in ICU, the longer it will take them to recover and to return to their home, their family and their employment.

At the start of the pandemic, the Women and Equalities Committee launched an inquiry into the unequal impact of covid. That has now split into three separate inquiries looking specifically at: the impact on disabled people and their access to services; the gendered impact of covid; and—the inquiry that we have launched within the last couple of weeks and on which we have already taken significant evidence—the impact on our BAME community. As I said to Committee members last week before we had the first evidence session, “If there is one thing you can rely on from the Women and Equalities Committee, it is that our inquiry will come up with recommendations for the Government to act.”

Yesterday we heard from Dr Chaand Nagpaul and Professor Kamlesh Khunti. I do not wish overly to paraphrase their evidence, but I only have six minutes so I really will have to. They both reiterated what can be found in the NHS England and NHS Improvement briefing on the disproportionate impact of covid—that BAME staff are over-represented in the lower grades of the NHS hierarchy, that there is not enough diversity in management structures, and that, as a direct result, BAME staff are worried to speak up when they do not have the right PPE. Those staff are not having their voices heard—or, worse, they are too scared to use their voices. That is Britain in 2020: BAME staff in the NHS are scared to speak up. We have to make sure immediately that channels are open for people to be able to do so, whether they work in the NHS or in other frontline roles such as bus drivers, retail workers and nursery assistants—the people without whom, to be blunt, our country would have ground to a halt over the course of the last 12 weeks.

The Committee heard from Professor Sir Michael Marmot, who did a review back in 2010. He refreshed his review in February this year—hard up against the start of the crisis.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The right hon. Lady makes a valid point about the NHS, in which there is not a great record on whistleblowing but at least many of those workers would be in regular jobs. Does she agree that there is a disproportionate number of black, Asian and minority ethnic people in insecure employment, for whom raising an issue could mean losing their jobs? They should not have to make that choice.

[Caroline Nokes]

The hon. Lady is absolutely right. That is why I specifically raised those who are working in transport and the gig economy, who do not have those routes. In the NHS they should at least be there; in some sectors, they do not exist in the first place.

We heard from the hon. Member for Brent Central some uncomfortable truths—issues that may be difficult for us to hear—but we cannot just listen and review; we must act. When I rather proudly told one of my constituents, as Chair of the Women and Equalities Committee, that we had launched an inquiry, her instant response was not great: it was, “Not another inquiry. Not another review. Please, can you come up with some action?” She was right.

The race disparity unit in the Cabinet Office was set up specifically to obtain data, but it needs to do more than just get data. It needs to be able to look at datasets and understand them—of course it does; we have to know where the structural inequalities lie—but it is of no use to accurately record a growing deficit, or perhaps a shrinking deficit. We have to have actions. We need policy levers to effect change, so that the young Caribbean boy in the constituency of the hon. Member for Brent Central has the same educational opportunities as the white girl in mine; so that the job opportunities and chances of progression in work—and that is absolutely key: it is about not just getting a job but getting a good job getting, a better job—are available whatever someone’s ethnicity; and so that someone’s ability to speak out when they do not have the right PPE is the same regardless of their gender, ethnicity, religion, age, sexuality or disability.

I cannot stand here and predict the outcome of my Committee’s inquiry—it would be wrong to do so—but I can predict that we will expect delivery from Ministers, not warm words, not more reviews and not more commitments to get better data. We want action and improvement.

Covid-19 is of course a novel virus and we have been forced to learn about it at pace, but it has highlighted health inequalities that are real and current: if someone lives in overcrowded, poor-quality housing, they are more likely to be negatively impacted; if someone is in frontline, public-facing work, they are more likely to be negatively impacted; if someone’s English is poor or they have learning difficulties, they will not be able to receive the important public health messages that they need; and if someone lives in multigenerational families, they are more likely to be negatively impacted, as are those whose work is insecure. Of course, a person may well have no choice but to carry on working at the height of a pandemic to feed their family. No one can be a careworker, a retail worker or a transport worker from the safety of their own home.

We have not had a public health crisis like this since the Spanish flu 100 years ago, and I do not know whether our generation will see another, but we cannot lurch to another crisis without having worked out how to risk-assess our frontline workers; without having established culturally intelligent ways to disseminate information; and without having empowered people in the workplace to voice their concerns and enabled the routes to redress.

I know that the Minister and her colleagues across Government will work hard on this issue. We heard last week from my hon. Friend the Minister for Equalities about the importance of the work that the race disparity unit is doing, but I urge the Minister present to come forward with what is actually going to happen, because that is what our BAME communities up and down the country wish to hear.

--- Later in debate ---

[Ms Nusrat Ghani (Wealden) (Con)]

It is a pleasure to follow the passionate speech of the hon. Member for Slough (Mr Dhesi). I first want to thank all NHS workers, who have done a tremendous job during this covid period. My speech will not be so friendly, so I want to start by thanking the Minister, who has been tremendous in supporting me in Wealden, where we have a particularly large care home system—I have a lot of older constituents. Regardless of the day of the week and the time of day, she has been incredibly responsive. Unfortunately, the rest of my speech will not be so flattering, so I will just crack on.

Like so many people in this country, I have lost loved ones to covid. I also have loved ones working on the frontline dealing with covid. We had the experience and network to highlight quite early on that we saw a pattern forming, but we were met with, “We don’t have the data”—it is 2020, and we do not have the data. I understand the argument that this is an unusual situation, and that we did not have the statistics to deal with this particular pandemic, but we do have data about how viruses spread. We also understand the long-standing institutional biases of NHS England and Public Health England, which have failed in their leadership, are unaccountable, and hide behind the catch-all, “We just don’t have the data.” It is shameful.

[Caroline Nokes]

Does my hon. Friend agree that we did not actually need data, given that we could open up the pages of any newspaper and see the photographs?

[Ms Ghani]

I agree with my right hon. Friend. That goes back to my earlier point: Public Health England needs far more functioning leadership.

Public Health England’s report says:

“It is clear from discussions with stakeholders the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities in the UK.”

That is nothing new. Moreover, it confirms to me the wilful blindness of Public Health England and NHS England in addressing racial inequalities and their inability to put in place measures to address workplace risk and make sure that so many BAME staff were not exposed. In the time it took for Public Health England to review the disproportionate number of BAME deaths, another 17 doctors passed away. Sixteen of those were BAME.

What else do we know? We know that there is a significantly higher proportion of BAME healthcare workers in England across our health system; without BAME workers, there would not be a health system. We know that BAME workers are in lower-paid jobs and that they cannot work remotely. We know that BAME workers tend to work in high-risk areas, and that the families they go home to are high-risk individuals. It was a high-risk strategy, yet Public Health England and NHS England continued to expose high-risk staff to high-risk shifts.

We know that 94% of doctors who died were of a BAME background. In the biggest survey of its kind, ITV News asked the UK’s BAME healthcare community why they thought more of their BAME colleagues were dying than their white counterparts, and 50% felt that discriminatory behaviour played a role in the high death toll. One respondent described the treatment as “very unfair”, adding that “all BAME nurses” have been

“allocated to red wards and my white colleagues”

are “constantly in green wards.” Perhaps more worryingly, ITV found that 53% of BAME respondents said that they felt they could not comfortably raise concerns about deployment, so they risked their health as against their employment.

To me, that suggests that the problem is related not to covid but to long-standing institutional inequalities. I want to hear from the Minister a resolute commitment to hold Public Health England and NHS England to account, and to ensure that the recommendations are acted on, reviewed and assessed by the real workers on the frontline who are most at risk—by that I mean BAME workers—and that all the data, good and bad, is shared in good time. I hope that the Minister understands that I have very little confidence in particular in Public Health England.

As we champion our frontline key workers, we also need to give them confidence that we have their backs. Like all public workers, they want to do their jobs, but many are concerned that if there is a second wave of covid they will be risking their lives or their families’. The BAME community has already been severely hit. I am not sure that it could take a second wave. For BAME health workers to die at such a rate frankly amounts to negligence on the part of NHS England and Public Health England, but perhaps it is not that surprising. Their leadership boasts 46 individuals; yet only four of them are from BAME backgrounds.

The country was united in tackling covid, but Public Health England and NHS England let down BAME health workers. They have time to put the record straight. Either we are in this together or we are not. I hope that the Minister can confirm that the Department is committed to ensuring that Public Health England and NHS England will treat, manage and support all their staff equally, so that we do not see a second wave of disproportionate BAME health worker deaths.

Covid-19 Response

Caroline Nokes Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

The hon. Lady is absolutely right to raise that. It appals me that people would try to raise a scam in response to this mission-critical national project of NHS Test and Trace. NHS contact tracers will never ask for your personal financial information. They will never ask you to pay for anything, and they will never disclose your personal medical information. If any of those things start to happen on a call, it is not a call from NHS Test and Trace. We have worked closely with the National Cyber Security Centre to ensure that we get the scripts right and that we protect against these risks, and she is right to raise it.

[Caroline Nokes (Romsey and Southampton North) (Con)]

My constituent Dr David Flavell, the scientific director of Leukaemia Busters, has sent a face mask to every Cabinet member, every shadow Cabinet member and, indeed, the entire Health and Social Care Committee. I hope my right hon. Friend has received his. Will the Government consider upgrading their advice on the use of face masks from recommended to mandatory?

[Matt Hancock]

I have not received mine, but I would like to. Let us try to find it, wherever it has got to in the system—it might be in the bowels of the Department of Health and Social Care somewhere. I will go and dig it out; that is an unfortunate image. The serious point is that face coverings are important, especially in areas where you might come into contact with people you would not otherwise frequently see, such as on public transport or in some shops. I will look into the issue that she raises.

Coronavirus Bill

Caroline Nokes Excerpts

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

There have been some fantastic speeches this evening so far, including from my hon. Friend the Member for High Peak (Robert Largan) who made a stunning maiden speech, but I wish to go back to the words of my right hon. Friend the Secretary of State when he said that the virus impacts most the weak and vulnerable. He is of course right.

I support the measures in the Bill. They are extraordinary measures that can only be used in extraordinary times, but that is exactly what we are facing. Tonight I wish to speak for the weak and the vulnerable, as hon. Members might expect from the Chair of the Women and Equalities Committee. I have real concerns about how equalities might be impacted and about how those people with protected characteristics for whom we speak might be affected. I draw particular attention to the elderly, who we know are the most impacted by this disease, and their need for care that is appropriate in their own homes at the right time. I speak for the disabled, who of course have the biggest challenges and who desperately need assistance. I appreciate why we have the powers in the Bill, but they must be used proportionately and reasonably.

I also speak for those from black and minority ethnic backgrounds, and, of course, the Paymaster General, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), has done some phenomenal work with faith communities, making sure that funerals can be held appropriately for religions. But I would like to point out that it is in the gig economy where we are most likely to find people from a BAME background working: they are also most likely to be young people. They are also most likely to be self-employed, on zero hours or sole traders, and we must be particularly cognisant of the impact the virus will have on those people who we will want—when this horror is over—to be able to bounce back to be the entrepreneurs who will enable our economy to recover from this difficult period.

I will also, of course, mention women. We know that caring responsibilities fall most heavily on their shoulders. We also know that in areas such as childminding, childminders are not only doing the caring, but of course are providing the support that enables women to go out to work, whether it be in our essential professions at the moment or in all parts of the economy. We must provide support to the childminding sector as well as the early years sector, because when the virus is quashed and we are in a position to rebuild the economy, we will need childminders to enable that 50% of the workforce to go back to work. We have done great work over the past few years in making sure that there are more women in employment, but we have to make sure that it is possible for them when this is over to be able to—

[Steve Brine]

That is exactly the point: so many of the early years sector and childminders are self-employed. That is another reason to repeat the point that so many have made today about why we need something for that part of the economy.

[Caroline Nokes]

My hon. Friend is right, so I have managed to fit in the childminding sector and the self-employed in one hit.

I want also to speak about volunteering and the clarity that is needed. There is a great company in my constituency that runs Kimbridge Barn. That is shut, of course, but the company wants to enable its staff to volunteer, whether in the health service or the care sector, or as delivery drivers—it has many vehicles—but it wants clarity as to whether the 80% of salaries that HMRC will underwrite will be applicable if people are effectively outworking in a voluntary capacity.

I also draw attention to the comments made by my right hon. Friend the Member for South West Surrey (Jeremy Hunt) about whether local government officers should be considering planning applications at the current time. I would also ask whether they should be implementing or imposing parking fines. Those are all areas of regulation that are undertaken by local authorities that are far from an imperative at the current time.

I would like to pay tribute in the voluntary sector to both Southampton Voluntary Services and Unity in Test Valley, who have done some brilliant work pulling together volunteer bureaux and making sure that people in the shielded group will have the support from people in the community who can help deliver medicines and essential shopping.

There is much in the Bill that in ordinary times we would not consider, but I end with one final plea about parliamentary scrutiny. There is as yet no mechanism or ability under Standing Orders for Select Committees such as the Women and Equalities Committee—which has much to scrutinise in the Bill—to meet remotely by video link, by Zoom, by Skype for Business or through any other mechanism. I understand that the Leader of the House will make a statement at some point. I very much hope that he will make sure that, at the very least, the Select Committee structures can work at this time to ensure that measures such as this are held to proper scrutiny, so that we understand how they are impacting on the most vulnerable.

Covid-19

Caroline Nokes Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

I discussed this issue with the hon. Member for Leicester South (Jonathan Ashworth). The delivery of support to make sure that nobody is penalised for doing the right thing is incredibly important but, as the hon. Lady says, there is no employer for those who are self-employed, so it has to be delivered through the benefits system.

[Caroline Nokes (Romsey and Southampton North) (Con)]

With flight restrictions around the world, many of us have constituents who are stuck abroad. Will my right hon. Friend provide reassurance that consular assistance is available and that he is working closely with the Foreign and Commonwealth Office so that stranded constituents in countries that have imposed flight bans can get home?

[Matt Hancock]

Yes. That is an incredibly important point that I discuss regularly with the Foreign Secretary.

Coronavirus

Caroline Nokes Excerpts

Monday 9th March 2020 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

Home working is all but impossible in the early years sector, in which employers tend to be small and medium-sized enterprises and employees tend to be women. I have been contacted by nursery owners in my constituency who are extremely concerned that the advice they are getting from Government helplines is not consistent. I urge the Secretary of State to make sure that the information provided to these essential businesses in a crisis is consistent and kept up to date.

[Matt Hancock]

Yes, absolutely, and if my right hon. Friend could bring the individual concerns to my attention, I would be very happy to look into them.

Eating Disorders Awareness Week

Caroline Nokes Excerpts

Thursday 5th March 2020 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

I thank the Minister for giving way; there is nothing more aggravating than somebody coming very late to a debate, but I have been in the International Women’s Day debate all afternoon. On relapse or eating disorders continuing into adulthood, does she agree that we have made massive strides forward in treatment for young people, but that there remains a problem of transition when sufferers turn 18? For those who develop an eating disorder slightly after their teenage years, or even well into adulthood, there is still a challenge in accessing services for those not eligible for children’s services.

[Ms Dorries]

My right hon. Friend makes an important point. That is why we invested £2.3 billion in mental health services, which, as I always say, is more than half the entire prison estate budget. We are focusing on young people and young women in this debate, but funding for mental health services is growing faster than the overall NHS budget. That funding and the development of community services is there to pick up exactly the cases she cites.

No mental health service, other than the very extreme, is better delivered in a hospital than in the community, whether for children, young people or adults. Despite that investment in community mental health services, our challenge is unprecedented, and our challenge is about workforce—it is about attracting people to work in this arena and to help us develop the community services that we need to provide treatment for adults and young people. That is the challenge we have taken on, and it is a challenge that we are meeting and moving forward with. It is our ambition and my absolute hope that children, young people and adults, regardless of their age—this illness is severe, whether in adults or children and young people—receive the treatment they require, when they require it.

Coronavirus

Caroline Nokes Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

There is a huge number of things that we need to do in the next few days and, as I have said, this area is under review.

[Caroline Nokes (Romsey and Southampton North) (Con)]

Across Government, in different Departments, there are many people with healthcare experience and professionalism. For example, the Department for Work and Pensions has 3,000 trained professionals working on assessments. What conversations is my right hon. Friend having with other Secretaries of State to understand whether there could be access to those individuals so that they too could be on the frontline?

[Matt Hancock]

That is something we are absolutely willing to look at.

Oral Answers to Questions

Caroline Nokes Excerpts

Tuesday 29th October 2019 Commons Chamber

[Jo Churchill]

That was part of the prevention Green Paper. We have the consultation responses, which we will assess and come forward with proposals.

[Caroline Nokes (Romsey and Southampton North) (Ind)]

There is still too much reliance on body mass index as an indicator of good health in sufferers of eating disorders. Will the Secretary of State get behind the “Dump the Scales” campaign and meet the indomitable campaigner Hope Virgo, to ensure that GPs realise there is more to eating disorders than just weight?

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

I thank my right hon. Friend for her question. The National Institute for Health and Care Excellence guidelines state clearly that GPs should not use BMI as the sole indicator for treatment. I have just met the eating disorder charity Beat to discuss how we approach eating disorders. With the £2.3 billion that we have invested in mental health services, we have made a commitment that any young person presenting with an acute eating disorder will be seen within one week, and others within four weeks.

Southern Health NHS Foundation Trust

Caroline Nokes Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Alistair Burt]

Let me point out that we have announced an increased resource for mental health of £11.7 billion. The extra £1 billion that the Mental Health Taskforce recommended being spent by 2020 will be spent, and it will be spent right across the board from perinatal mental health to crisis care. It will also improve baselines to ensure that the governance and quality of foundation trusts are good enough, and we are watching what CQCs are spending. Yes, we recognise that there has been historical underfunding from Governments of all characters, but we are determined to improve it and the money is there.

[Caroline Nokes (Romsey and Southampton North) (Con)]

All too often it is our constituents with mental health problems and learning difficulties who find it hardest to get their voices heard. Those who are patients of Southern Health are not in a position to call for urgent change. I note that the Minister has said that the delivery plan is being evaluated, but can he reassure us that that is being done with the utmost speed so that we see improvements on the ground and not just more reports gathering dust?

[Alistair Burt]

Today, I met departmental officials and spoke to the regional director responsible for NHS improvement and, as I mentioned earlier, the deputy chief inspector of the CQC who is responsible for this report. I can assure my hon. Friend that, in so far as it is up to me or the Department, that change will be adequately delivered with a sense of urgency, because, as she rightly says, patients and families have, in some cases, waited much too long for this. If warm words are to mean anything, we must show that delivery follows.

Brain Tumours

Caroline Nokes Excerpts

Monday 18th April 2016 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

I add my congratulations to the Chair of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), on the Committee’s excellent report, and to every Member on today’s thoughtful debate. I pay particular tribute to colleagues who spoke movingly about their own experiences or those of people close to them.

I will briefly mention one of my own constituents, but first echo the comments of my hon. Friend the Member for North Dorset (Simon Hoare) about Sacha Langton-Gilks. It is clear that someone is a dedicated and doughty campaigner when they not only attend the surgeries of their own Member of Parliament, but pitch up at those of other Members. Sacha came to see me when I was a new MP—bringing with her the legal requirement, one of my constituents, who introduced her—and spoke incredibly movingly about her son, David. She also brought with her the HeadSmart cards and emphasised the importance of early diagnosis and the HeadSmart campaign, which seeks to bring awareness to schools, doctors and, particularly, parents. As a result of that meeting, I was able to introduce her to the leader of Hampshire County Council, who agreed for those cards to be distributed in Hampshire schools. Those cards are incredibly informative, outlining symptoms in an age-specific way and, above all, not provoking alarm; they just educate people. It is important that we increase awareness of brain tumours without instilling fear in people.

[Rebecca Harris]

I, too, commend the HeadSmart cards, but does my hon. Friend agree that unless the medical profession is more aware of brain tumours we will run into the problem, as we have time and again, that it overlooks parents’ instincts in such cases?

[Caroline Nokes]

I pay tribute to my hon. Friend’s work as chair of the APPG, and I will highlight exactly that situation with the case of a constituent. Brain tumours are not as rare as we might think; they are the biggest cancer killer of children. That is why I argue that research and knowledge are critical.

I received an incredibly moving letter from my constituents, Charlotte Swithenbank and James Butler, the parents of Alfie, who is not yet two years old and has been fighting his cancer for more than a year. As in many cases, Alfie was not initially diagnosed. It was not until his seventh trip to the doctor in just two weeks that he was referred to Southampton general hospital. Within 36 hours of admission, he was diagnosed with a grade 3 infant ependymoma, and he has since had more than 24 hours of surgery. He has also had chemotherapy.

[Simon Hoare]

Does my hon. Friend agree that there may be a correlation between a perception that brain cancers and brain tumours are somehow lower down the pecking order and the fact that GPs are less inclined to refer? They do not necessarily see them as part of the great initiatives of the Department.

[Caroline Nokes]

To be brutally honest, I do not know, but I agree with the chair of the APPG that it is critical that the medical community be incredibly aware of such cancers and make referrals as quickly as possible.

Alfie has been for proton beam therapy in the USA and has lived in hospital for more than five and a half months of his short life. He is scheduled to have his MRI today, which is why his parents are not here; I am sure that they will catch up with the debate later. That MRI will, we hope, establish whether Alfie has gone into remission. We want that news to be positive, but as his mother, Charlotte, says, even if Alfie is now in remission, given the type of tumour he has, there is a 50% chance that it will return within seven years. As a family, they will live in fear even if he has gone into remission.

Charlotte also says that early diagnosis is key. It was her persistence in going back to the GP time and again, and refusing to accept that it was just an ear infection, that meant that Alfie’s diagnosis, in comparison with many, was relatively quick. That got him referred to an excellent children’s unit, which has helped him to have a fighting chance.

Charlotte has sought to convey to me how urgent this issue is. Unlike other cancers, the incidence of brain tumours is rising and the improvements in outcome that we have seen in other cancers have not been matched in brain cancers. In Southampton, we are incredibly lucky to have the Cancer Research UK unit located adjacent to the general hospital. MPs are invited there every year to hear about the work it does and to see graphs that show that, for the majority of cancers, treatment rates are more successful and incidence is going down. However, for brain tumours, those are going in the other direction; the cures have not been as forthcoming as for other cancers.

We are all here today to convey the message to the Minister that we want more investment in research in this field, so that more parents do not have to go through what Charlotte and James are going through, and more children like Alfie have the best possible chance of a positive outcome.