Mental Health

Caroline Nokes Excerpts

Thursday 16th May 2013 Commons Chamber

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

I add to those of other Members my congratulations to the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate, and indeed to the Backbench Business Committee on having agreed the time for it.

I fear I shall stray into what some Members might regard as rather a niche area of mental illness. Some will recall that I led a Westminster Hall debate several months ago on the topic of eating disorders, raising the connection between eating disorders of whatever type and other mental illnesses.

One of the sadnesses I encountered in the run-up to that debate was the trivialisation of eating disorders even by some fellow Members, who made the point that they were not serious conditions but just the afflictions of silly teenage girls who needed to get a grip on their eating patterns. Far from it: in fact, eating disorders are one of the most prevalent mental illnesses. There are thought to be some 1.6 million sufferers in the UK. Anorexia nervosa is the most lethal mental illness: 20% of sufferers eventually die from it and a further 20% never recover.

It is important to recognise that the symptoms of a wide variety of mental illnesses such as low self-esteem, physical abuse and alienation from peers are common traits in a wide range of mental health problems, and are often particularly manifested in eating disorders. As I have said previously, the route map to an eating disorder is not identical for everybody, but similar traits and commons themes can be found. The same route map and traits can be found in schizophrenia and serious personality disorders such as bipolar disorder, for example.

I want to pick up and draw on as a point of contrast the issue of borderline personality disorder. I want to make the point, hopefully as succinctly as I can, that eating disorders are not the poor relation of more serious personality disorders and mental health problems; they are a serious condition of the psyche that should command far greater public awareness and, indeed, greater public spending.

To demonstrate the significant threat posed by eating disorders, one need only make a comparison with a more well-known and recognised mental health problem such as borderline personality disorder. BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder and is thought to be present in about 2% of the general population. It has a phenomenally high rate of suicide and self-harm: 10% of BPD sufferers eventually commit suicide. Those mortality rates are augmented by disorder-related deaths from drug or drink abuse. One of the most well-known cases of undiagnosed BPD was that of the singer Amy Winehouse, who eventually died from alcohol poisoning.

However, anorexia nervosa—like BPD, it is thought to affect roughly 2% of the population—has a 20% mortality rate, which is nearly twice that for BPD. Yet awareness of this shocking statistic is not high; people simply do not know about it. That could be because, unlike BPD, those deaths do not predominantly come from suicide—although that is not uncommon—but happen many years later after the physical effects of anorexia have taken their toll. Many of the deaths occur from multiple organ failure or heart attacks, in addition to the straightforward and more well-known effects of the sufferer having too low a body weight for them to survive.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the hon. Lady on the persistence with which she has raised this issue and the trenchant way she argues her case. She will be aware that one of my concerns is type 1 diabetics who, by manipulating their insulin intake, can achieve rapid weight loss, which is in itself a form of eating disorder. Does she agree that the major problem confronting these people is falling between two stools? On the one hand they get physical treatment for the physical consequences of their rapid weight loss—organ damage and so forth—while on the other they have difficulty getting access to proper psychological or psychiatric services. Does she agree that the two need to be more integrated?

[Caroline Nokes]

I thank the right hon. Gentleman for that timely intervention. That is one of the key problems. Far too often in eating disorders, the treatment is focused on body-mass index and ensuring that the sufferers are physically well, but without necessarily addressing the underlying cause through therapies and treatments that deal with what triggered the condition. The right hon. Gentleman’s example of diabetics who manipulate their insulin intake is a particularly stark one. Anyone who has done work with diabetics knows that incorrect levels of insulin can lead to horrendous physical complications. Across the whole spectrum of eating disorders, there is far too much focus on physical and too little on mental well-being.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I would not normally intervene, but will my hon. Friend join me in paying tribute to the right hon. Member for Knowsley (Mr Howarth) for the great work he has done to raise with me and my Department this often unheard of, certainly unrecognised and very serious problem of type 1 diabetics with eating disorders? In considering how to tackle it, it is indeed important that we look at the mental conditions and problems my hon. Friend has identified.

[Caroline Nokes]

I certainly join the Minister in paying that tribute. I am delighted to hear her make the point that we must start addressing the underlying mental health conditions, when in too many cases the physical treatments are the sole emphasis.

I want to touch briefly on the significant impact eating disorders can have on future career opportunities and in the workplace. As I said earlier, eating disorders are often trivialised and generalised as being conditions affecting teenage girls. That is far from the truth, as the highest rate of increase is among male sufferers. In addition, many eating disorder sufferers are managing their conditions over many years or even decades. I am the first to emphasise that sufferers can be of any age and of either gender, although I acknowledge that the age at which an eating disorder is most likely to manifest itself is 17, and that it is most likely to do so in girls. It often occurs in academically high-achieving individuals who put themselves under immense pressure to be absolutely perfect in every way they can. That frequently manifests itself in a control of food intake. Those determined to put themselves under significant academic pressure also put themselves under massive physical pressure and wish to conform to a body ideal that is actually far from healthy.

I want to pay tribute to the work of April House in Southampton—a specialist unit that focuses on eating disorders in the city. I paid a very enlightening visit to the centre just over 12 months ago and met a number of sufferers, several of whom came from my constituency. Although April House serves the wider Southampton area, three of them were Romsey residents. They have kept in touch with me since my visit, and have emphasised that they have not only benefited from the work done at April House, but have undertaken other therapies.

I am very aware of the work of an organisation in Southampton called tastelife, which was set up by the families of people suffering from eating disorders. The aim was to move the focus away from the physical, and, through self-help groups, to encourage sufferers to talk about their issues, work through them with other people and concentrate on not just physical but mental wellness.

I pay tribute to the hon. Member for North Durham (Mr Jones), who drew attention to the stigma experienced not only by those who suffer from mental health problems, but by their families. Before the Westminster Hall debate, I was contacted by many parents, husbands and, indeed, wives of people with eating disorders, who told me that not just their relatives but they themselves suffered that stigma. A number of them believed that they must be in some way to blame for the fact that their relative, perhaps their child, suffered from an eating disorder. Many were suffering from massive levels of guilt and introspection because they felt they must have somehow caused it.

I have tried to emphasise during discussions of this topic that it is not possible to identify a single trigger, and that a parent cannot do anything to prevent the descent of a child into a form of mental illness, but what that parent can do is help. I was pleased to hear various Members stress the importance of having a parent or other relative as an advocate. In the case of eating disorders, it is almost inevitably the parent who will know the young sufferer best. I think it very important that we be prepared to talk openly about the subject and to move away from the stigma.

Many of those who attended the Westminster Hall debate will remember my hon. Friend the Member for Braintree (Mr Newmark) talking about a pea. He described how he had suffered at school from anorexia nervosa, and had decided to address his condition by seeking to tackle it one step at a time. The first step involved a single green pea on a plate, which he pushed around endlessly, trying to summon up the ability to eat it. His was a moving and interesting account, which gave those of us who had by then been debating the issue for some hours something on which we could really focus: that vision of a plain white plate with a single green pea on it.

Unfortunately the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is no longer in the Chamber. I am sure the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will do an admirable job in responding to the debate, but the point I am about to raise is one that I raised with the Minister of State after it was raised with me by an organisation called Anorexia and Bulimia Care.

Once a young person suffering from an eating disorder has turned 16, they can choose to accept or refuse treatment and their parents no longer have a say. In order for them to be force-fed, they must be sectioned. That brings me back to what I said earlier about teenagers who are in the middle of academic exams and approaching A-levels. Being sectioned could have a significant impact on their future career choices.

I am not necessarily suggesting that we should insist that the parents must be in charge until a child reaches the age of 18. The Children’s Minister explained to me carefully and clearly about previous rulings in this place and in the courts which have granted people Gillick competence at an earlier age. I am not saying we should insist that that right be taken away from eating disorder sufferers. I think it important for us to work with health care professionals, and with mental health experts in particular, to find a solution to what I regard as a very knotty problem.

Among the sufferers to whom I have spoken during various meetings at April House and elsewhere, one sticks especially keenly in my mind. She was a lady my own age, and, although she was not one of my constituents, she came from Hampshire. She had suffered from anorexia for decades, and was incredibly frail. When I mentioned April House she shuddered visibly, because she regarded it as a place where she had been effectively force-fed. She had not come through the treatment successfully; here she was, 20 years on, still suffering from anorexia nervosa.

I always find myself—with good reason, I believe—on the side of the sufferer or the patient, and I am therefore not suggesting to the Minister that when it comes to the debate about whether parents should have the right to insist on force-feeding young people until they reach the age of 18, we should enter the fray. I recognise it is a very difficult area. However, I want to leave that thought with the Minister. I have raised the issue with her colleague the Minister of State, and no doubt I will raise it again over the coming months and years.

Sudden Adult Death Syndrome

Caroline Nokes Excerpts

Monday 25th March 2013 Westminster Hall

[Steve Rotheram]

Absolutely. What campaigners, or indeed anyone who is sensible enough to understand that we are in times of austerity, will say is that it is not for the Government to do everything. The example given by my hon. Friend of £40,000 being raised and the example of the OK Foundation, which has put defibrillators in all Liverpool schools, and of other organisations that are doing sterling work, prove that this is a partnership. This is something that charities can help with, but it does demand action from the Government.

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

I congratulate the hon. Gentleman on securing the debate. Will he join me in congratulating small communities such as Lockerley in my constituency? I learned on Friday night that there is a defibrillator in the village hall, and I was told at a meeting there of, I have to say, predominantly quite elderly people that the instructions for the defibrillator were very easy to understand. They made exactly the point that the hon. Gentleman makes: the machine talks people through the process.

[Steve Rotheram]

Yes. Certain people expect us, as parliamentarians, to know everything about everything, but actually we do not know an awful lot about an awful lot. I hope that if it does nothing else, today’s debate and the publicity that will be generated through the campaigners will ensure that people are aware of exactly the point that the hon. Lady raises.

Backbench business

Caroline Nokes Excerpts

Thursday 14th February 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Osborne. I pay tribute to the Backbench Business Committee for granting this three-hour debate. I know that the Committee had to negotiate with the Liaison Committee so that we could hold the debate during eating disorders awareness week. This debate is therefore timely as well as important. Others in the House clearly agree, as can be seen by the number of hon. Members present. I know how difficult it is to commit to this slot on a Thursday afternoon, particularly when serious issues such as violence against women are being debated in the main Chamber. I am conscious that several Members are trying to perform the parliamentary feat of being in two places at once.

Eating disorders have not been debated in the House since 2007, a considerable time ago, yet over the course of the past few weeks I have become aware of several hon. Members and members of staff with family connections to those with eating disorders. Just this afternoon, I received an e-mail from an hon. Member’s chief of staff, who told me the moving and difficult story of his wife’s experience with an eating disorder. I pay particular tribute to my hon. Friends the Members for Enfield, Southgate (Mr Burrowes), and for Wells (Tessa Munt), and the hon. Member for North Tyneside (Mrs Glindon), who applied with me for this debate and have significant knowledge of and interest in eating disorders.

Some 1.6 million people in this country have been or are currently known to be affected by eating disorders. That is a massive number, equivalent to nearly 2,500 in every parliamentary constituency. However, the number of unknown sufferers is also of significant concern. The true number of those who suffer is not fully understood owing to the paucity of data relating to those who are not in the system. The Department of Health acknowledges that unreported cases of eating disorders are a huge problem, and the true figure could be higher than 4 million, which is 6.5% of the UK population, or about 7,000 people per constituency.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

Those statistics are staggering. As someone relatively new to the issue, I was not aware that the numbers were quite so large. How many of those people are men, and are there data identifying the proportion of sufferers who are men of whatever age, and the proportion who are young men?

--- Later in debate ---

[Caroline Nokes]

My hon. Friend raises an important point. It is thought—I emphasise “thought”—that about 11% of sufferers are male, but interestingly, they are among the fastest-increasing groups.

The figures that I have given do not take into account the families of those who suffer, meaning that the social footprint of eating disorders is breathtaking. Be assured—to refer back to my hon. Friend’s point—that sufferers are by no means all teenage girls. That is one of several myths about eating disorders that need to be exposed.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

A constituent of mine, Cherie Hinchliffe, wrote to me saying how pleased she was that the hon. Lady was holding this debate. She wanted to say that eating disorders destroy families, and that GPs do not know enough about them. Doctors, dentists, local hospitals and schools do not know enough about them; the media know about them but report them in a terrible way. Does the hon. Lady agree?

[Caroline Nokes]

The hon. Gentleman is absolutely bang on. Many parents of sufferers have commented to me that they feel their GPs do not understand enough, and nor do schools and colleges. I will cover all the points that he raised later.

The fastest increase in eating disorders has been among young men. As well as facing the mental health problems typically associated with female sufferers, they are coming under more pressure than ever before to conform to a stereotype of the body beautiful. Imagery in magazines and advertising plays a significant role.

Of particular concern is the prevalence of eating disorders among gay and bisexual men, who are twice as likely to be sufferers as heterosexual men. I understand that eating disorders in gay and bisexual men are even more linked to concerns about body image than in heterosexual male or female sufferers. Although males account for only 11% of the total of those with eating disorders, the percentage is increasing, and we should be conscious of that. In the 10 years up to 2011, the number of hospital admissions for men suffering from an eating disorder rose by 67%. Furthermore, there is evidence that undiagnosed disorders are even more commonplace among men than among women. The scale of the hidden problem could be immense.

It is not only the young who are afflicted, although there is certainly a trend towards eating disorders manifesting at an earlier age than ever before. I was particularly moved by my contact with a woman whose daughter started suffering from anorexia nervosa at 10 years old but was not diagnosed for years, as her GP and other medical practitioners thought that she was too young to have the condition. Eating disorders are also being diagnosed much later; some sufferers present in their 50s and 60s, and there is evidence that increasing numbers of sufferers manage their conditions not just over the average of seven years, but for decades. An increasing number of people in their 30s and 40s have lived with their eating disorder for more than 20 years.

“Eating disorder” is a term used to describe a wide variety of conditions, some well known and others far less so. Obviously, the best known and most recognisable is anorexia nervosa, in which a sufferer intentionally deprives themselves of food and has a body weight at least 15% below the recommended minimum. People with anorexia have an extremely distorted view of their own body and a fear of gaining weight. However, anorexia is but one condition among several. Eating disorders also include bulimia, which in many cases is harder to detect, as sufferers may maintain a normal-looking weight. However, it is achieved through bingeing, purging and fasting, and like anorexia it can cause long-term damage.

From my research for this debate and my conversations with many sufferers of eating disorders, I have learned of many other conditions: binge eating; compulsive overeating; food neophobia, an extreme fear of trying new food; and compulsive over-exercising. A year ago, I met a young man who ran up to 30 miles every day. There is also selective eating: sufferers eat only an extremely limited range of foods.

Bulimia is a disorder linked closely to low self-esteem, emotional problems and stress. The sufferer may think constantly about calories, dieting and ways of getting rid of food that they have eaten. It is actually more common than anorexia, but it is more hidden, because people with bulimia usually maintain an average or just-above-average weight. Bulimia can go unnoticed for a long time while sufferers feel incredibly ill and unhappy.

Those with bulimia become involved in a cycle of eating large amounts of food and making themselves sick, cutting down or starving for a few days, or trying to find other ways to make up for the food that they have eaten. It can cause them to become so hungry that they eat large amounts of food because their bodies crave nourishment. Some people do not vomit, but instead take laxatives, which are especially dangerous. Just because bulimia does not cause the extreme weight loss of anorexia does not mean that it is less serious. Sufferers need help and support, as the side effects and consequences can be serious. I appreciate that I have given a very rapid description of some eating disorders, for which I apologise, but I am sure that other Members will wish to discuss some of them in more detail.

I do not wish to generalise, and I apologise if my next remark causes any offence, but in many instances, due to the extreme control with which sufferers approach their food consumption, eating disorders are a type of addiction. However, unlike addictions to alcohol or narcotics, a fixation with how one controls one’s calorie intake must be faced and addressed every day of a sufferer or recovered sufferer’s life. They cannot simply remove food from their lives in the way that others might develop strategies to avoid alcohol, for instance. They must eat to live. For sufferers, by necessity, that battle will occur three times a day for the rest of their lives.

Eating disorders are not trivial conditions. Anorexia kills about 20% of sufferers, and 40% never recover. It is the single biggest killer of all mental illnesses. It has been dismissed for too long as a problem of teenage girls who just need to get a grip on their eating patterns. That is far from the truth. Eating disorders are serious, potentially fatal, mental illnesses, which, even long after a sufferer has recovered, can have long-term implications for their health. The impact on fertility is well known, but there are many other serious implications. Abnormal heart rhythms are commonplace, even in teenagers with eating disorders. In fact, heart damage is the most common cause of hospitalisation for those suffering from eating disorders, but the kidneys and liver are also badly affected, and reduction in bone density leading to osteoporosis can happen in sufferers, even before there has been any physical manifestation of a problem.

As chair of the all-party group on body image, I have been privileged to work with a number of leading charities supporting those suffering from eating disorders and their families. I pay particular tribute, during eating disorders awareness week, to Beat; many of its members are in the Public Gallery. I also pay tribute to Anorexia and Bulimia Care and the Succeed Foundation. I vividly recall hearing the moving stories of ABC members at a reception hosted by my hon. Friend the Member for Wells a few months ago. These charities all do fantastic work with sufferers and their families, and to ensure that the wider community—Members of Parliament, the medical profession, schools, colleges and universities—have a better understanding of the signs of eating disorders, and how to help those in the grip of such a disorder and those who may be at risk. They also work with the media to ensure that they understand the importance of the portrayal of responsible images on advertising and in editorials.

[Stephen Metcalfe]

My hon. Friend is making a powerful, moving speech. These issues have been discussed and debated before, but there seems never to have been any progress in addressing the issues and tackling the problems. Why does she think no progress has been made in the past 10, 20 or 30 years? These things were known about, yet there seems to have been no move forward.

[Caroline Nokes]

That is a difficult question. Later, I may even suggest that we are moving backwards. Unfortunately, these are hidden conditions that the media and others have chosen, occasionally, to trivialise. They are not trivial and they need much higher priority.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I congratulate my hon. Friend on securing this debate. On the subject of this being a hidden illness, in recent times mental health has risen up the agenda, and attention has been given to the topic in the House, which has shone a light on the issue of mental illness. Why, even in the field of mental illness, has this area in particular not received attention, when its mortality rates are the worst?

[Caroline Nokes]

My hon. Friend makes an important point about the mortality rates, compared with those for other mental illnesses. In this place, we have made great strides in being far more open and willing to discuss mental illness. This illness is hidden, and has not received priority or generated the attention that it so desperately deserves. It is incumbent on all of us to ensure that the Minister, who I am sure is listening, gets that message loud and clear.

[Jackie Doyle-Price (Thurrock) (Con)]

Whenever we approach a public health concern such as this, one of the biggest things we have to do is educate the public. The media are an important partner in that. Does my hon. Friend agree that the media’s obsession with the cult of celebrity, and the focus on that, is holding us back on a significant public health issue?

--- Later in debate ---

[Caroline Nokes]

My hon. Friend is aware of the work that I do with the all-party group on body image. We have been sending that message to the media time and again. We need more realistic images in magazines and publications. Shortly, I will quote a 21-year-old sufferer from anorexia who made that point to me powerfully.

The causes of eating disorders are complicated and varied, and although there may be broad similarities, it is dangerous to suggest that any two individuals will have identical experiences or paths into illness or recovery. I know from talking to sufferers, experts, charities and families that genetics, low self-esteem, stressful life events such as death or divorce, academic pressure and cultural and social pressures, can all contribute. For every sufferer there will be different triggers or different combinations of triggers. It would be naive to suggest that a single cause could be identified. However, an issue that brought me to this debate is the social pressure to conform to a stereotypical view of the ideal body image, so ably demonstrated to us in advertising and magazines.

Last November, I attended an event in this place organised by Anorexia and Bulimia Care, and was impressed by the moving account given by Katie Waters, a 21-year-old student, who told MPs:

“Six years ago the eating disorder well and truly look over. The stress of GCSEs in a high-achieving all-girls…school meant my weight dramatically plummeted and I…developed anorexia.

During this time I did everything—speech and drama exams, piano exams, I sang in the choir, I was in school plays, actively taking part in church activities and of course was buried under a mountain of homework. I constantly pressured myself to be perfect at absolutely everything.

But the trouble is, when it comes to weight and body size, the images I frequently saw in the media of apparent perfection were unattainable. We have only just been recently made aware in the last few years of the transformation airbrushing and digital photo techniques do to women’s bodies in the media. So what I was seeing from such a young, vulnerable and impressionable age was actually not a real person.”

To those who dismiss the impact of the images we routinely see in the media, I hope the words of Katie, and other sufferers like her, will hit home. Although I do not claim that such images are causing eating disorders, they are contributing to them, and editors and advertisers can work to portray more realistic and positive images.

I should like briefly to mention the relatively new phenomenon of pro-ana websites. First appearing in the 1990s, these sites are numerous and are often characterised by a frequent migration to different web addresses or blog sites. Ana, or thinspiration, is portrayed on many of these sites as not a serious mental illness, but a lifestyle choice, and although those supporting the sites claim that they can provide the only forum for socially isolated sufferers, solid academic studies support the claim that they do damage.

[Claire Perry (Devizes) (Con)]

I hope that you will accept my apologies for joining the debate late, Mrs Osborne. Does my hon. Friend agree that the progress we are making on making it much easier to filter out pornography, violence, abuse, anorexia and self-harm from the family home is welcome?

[Caroline Nokes]

I commend my hon. Friend on the work that she is doing in that area. I sincerely hope that we see some progress on that, so that these websites, which are proliferating—there is evidence of a 470% increase in just one year, between 2006 and 2007—can be prevented from being accessed from family homes. US studies have shown a clear correlation between increased body dissatisfaction and viewing such sites.

We live in a complex, changing world where higher numbers of people than ever suffer from mental illness, and so it is with eating disorders. It is not just the number of sufferers, but the severity, that is increasing. What would have been considered an eating disorder 20 years ago might now be regarded merely as a bit of disordered eating. I do not say that in any way to dismiss the seriousness of disordered eating, but to demonstrate that the conditions now have to be a great deal worse to be recognised as such, and to make a sufferer a priority for treatment. That is one of the serious issues that I would like to mention.

In my home city of Southampton—not in my constituency, but in that of the right hon. Member for Southampton, Itchen (Mr Denham)—is April House, a unit specialising in eating disorders, which I have had the privilege of visiting, and where I met service users and health care professionals. I attest to the outstanding work done there. Some of the service users and staff are here today. I admire their courage and determination.

I agree with the firm message that I received from staff at April House. With all eating disorders, there is a critical window of opportunity when a sufferer has been diagnosed, wants help, has acknowledged that they have a problem, and are reaching out for the assistance they desperately need. That opportunity can easily be lost if help is not available at that time.

[Lilian Greenwood (Nottingham South) (Lab)]

The hon. Lady is making a powerful speech. I was concerned when I received an e-mail from one of my constituents, a student nurse, who wrote:

“I am currently on a mental health placement and two of my clients have eating disorders of varying degrees, however cannot seek support for their eating disorder due to cuts in services.”

Does the hon. Lady share my belief that, having raised awareness of eating disorders and encouraged sufferers to seek help, we must not then fail to provide the support and assistance that they need?

[Caroline Nokes]

The hon. Lady makes exactly the point that I am coming on to: it is critical that when sufferers feel that they can reach out for help and acknowledge that they have a problem, the help is there for them. A delay of six to nine months can be dangerous—or, indeed, fatal.

[Jackie Doyle-Price]

Is my hon. Friend satisfied with the level of knowledge among medical professionals? Is there a job to be done in raising awareness of what they should be doing and of the signs that they should be looking for among sufferers of these disorders?

[Caroline Nokes]

I have been struck by the number of times that relatives of sufferers have contacted me to make the point that their family member was slow to get a diagnosis, or to say that the GP dismissed the eating disorder as nothing more than a teenager being a bit fussy about their food. It is critical to raise awareness, not only among the wider community and the media, but among our general practitioners, because we need these disorders to be identified earlier so that damage to growing bodies, in the instance of young people, does not become permanent.

[Stephen Metcalfe]

As well as the medical profession being aware of these conditions and the first signs, should not parents have some knowledge of the indications, so that they can help their children earlier, before the condition gets too serious?

[Caroline Nokes]

One of the messages that I have received from parents is that they already feel enormous guilt, in some instances completely unjustifiably. They feel shame for what is going on with their child, and as if they are somehow to blame. They are not, and I find that in the majority of cases, parents were the fastest to identify the condition. They instinctively knew that something was wrong with their child, even though they might not have been able to put their finger on what exactly it was. I have heard some terrible tales from parents, which I will come on to—I assure you, Mrs Osborne, I am getting towards the end—about the responsibility and burden placed on them. I have even heard about parents who have been told that it is their fault. It simply is not.

We do not fully understand what causes eating disorders; it is complicated. All the parents I have spoken to have done the most fantastic job in supporting their children. As one sufferer’s mother said to me on the phone just yesterday, there is nothing that she would not have sacrificed to get her daughter the help that she needed. Had the mother been able to buy private health care, she would have sold her house to do it, so desperate was she for her daughter to get well.

I know how long sufferers have had to wait to gain admission to April House—something that has been emphasised to me incredibly strongly—and the picture from around the country is that the average wait from diagnosis to treatment in a specialist unit can be as long as nine months. For sufferers, that is simply far too long. As we move from primary care trusts to clinical commissioning groups, it is imperative that awareness of the scale of the problem is uppermost in the minds of GPs, who will be responsible for commissioning the relevant services.

I have mentioned briefly one significant theme, but I would like to mention it again. It is a message that has come from the parents about the impact on families. The effects are many and varied, and certainly include huge feelings of guilt and despair, and lack of comprehension of why this has happened to their child, or why an individual might choose to deprive themselves of the necessary nutrition to lead a healthy life.

[Alison McGovern (Wirral South) (Lab)]

I apologise to the hon. Lady, who is making a brilliant case on behalf of the sufferers of eating disorders, for intervening on an excellent speech. Given the shame and guilt she has mentioned, which are big factors, does she agree that it is fantastic that constituents of mine have got in touch with me to ask me to attend this debate? All of us have constituents who have got in touch with us on this issue and have talked about their experiences. Their coming forward helps to dispel some of those feelings, and some of the myths and rumours surrounding these conditions. Will she congratulate them with me?

[Caroline Nokes]

I thank the hon. Lady for that intervention. One word that keeps being used is “stigma”. She is absolutely right to highlight the bravery of individuals, some of whom were perfectly happy to be named; when I told Katie Waters that I wanted to quote her, she was over the moon that I was going to quote her in Parliament. Others did not want to be named but still wanted to tell their story. They have all been phenomenally brave, including those in this place who have contacted me and talked about their personal stories.

I have had mothers contact me to tell me that when their child was diagnosed with an eating disorder, they were accused of abusing their child. The assumption was made that they must have harmed their child for her or him to have developed an eating disorder. I am not saying that that never happens, but from my experience, the parents and families of people with eating disorders have been caring, loving, supportive, desperate for knowledge and help, and in many cases prepared to sacrifice absolutely everything for their family member to be well again. I therefore pay tribute to charities such as Beat and ABC, which have recognised that this is not a condition of the individual, but affects entire families, wider networks, friends and colleagues.

Beat is working in partnership with Student Run Self Help, which runs a number of support groups in universities throughout the country. Both organisations have heard of a number of cases in which students have not been able to access treatment, or have been able to access only intermittent treatment, due to a lack of co-ordination and flexibility on the part of GPs and eating disorder treatment services at their university and in their home location. They have asked me specifically to highlight to the Minister the serious problem with 18-year-olds going off to university. We know that people are most likely to develop an eating disorder at 17, so that is a vulnerable age.

What sufferers need above all else is continuity and stability of treatment, which Beat originally thought could be achieved by enabling people to register with two GPs at one time. However, after consideration was given to who would have overall financial and clinical responsibility for the patient, discussion turned to the proposal that the home GP could have those responsibilities. This should encourage greater communication between the home GP and the GP with whom the student is registered as a temporary patient at university. In addition, it is likely to be argued that the student should be able to register with more than one eating disorders unit—one at home and one at university—so that they can receive the necessary care during both term time and the holidays.

I am conscious that other Members wish to speak and my contribution has been somewhat lengthy, so I shall conclude my remarks with a tribute to one of my constituents, whom I first met at April House this time last year. She has gone out of her way to keep in touch with updates about what she is doing to raise awareness of eating disorders. She has certainly improved my knowledge and understanding, and is shortly to take part in a charity sky-dive to raise funds for eating disorders awareness. What struck me about Becky was her willingness to open up about her battle with anorexia and some of the stark truths.

Hampshire is a fortunate county, with excellent schools and sixth-form colleges. Even in schools and colleges rated as excellent, however, eating disorders can flourish. Transition from school to college can be difficult for many, and at times of change, stress and pressure, eating disorders can frequently manifest themselves. Even where teachers and head teachers are good, concerned and caring, and where pastoral care is superb, young people can fall victim to these disorders. I hope that in some small way this debate has helped to raise awareness and understanding in this place. I sincerely thank all those in the Public Gallery for attending, and I thank colleagues for their contributions this afternoon.

--- Later in debate ---

[Caroline Nokes]

I welcome the right hon. Gentleman raising diabulimia, about which I knew absolutely nothing prior to calling this debate. A constituent of my right hon. Friend the Secretary of State for Communities and Local Government contacted me to inform me that treatment of the condition is incredibly rare, and they were aware of only one hospital in south London that specialises in it. Can the right hon. Gentleman confirm whether that is correct?

[Mr Howarth]

The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.

The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.

An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.

DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.

Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.

Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.

The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.

Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.

--- Later in debate ---

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.

[Caroline Nokes]

This is an important point. Last week, we had a controversy about La Perla using stick-thin models for its lingerie but, before Christmas, Marks & Spencer used some “larger ladies” in lingerie advertising. Some of them were almost a size 12. What would the Minister say to those in the health care professions who cited that advert as Marks & Spencer promoting and celebrating obesity?

[Norman Lamb]

I take the point and I am grateful for that intervention. We have to think before we speak on these things, to ensure that we do not send out confusing messages. There is a problem of obesity in our society and it is causing serious concerns about a drift towards type 2 diabetes and a whole series of health consequences, but let us be balanced in what we say and not confuse youngsters in such an unhelpful way. In the compelling words of Marya Hornbacher, in her memoir of anorexia and bulimia, we are “turning skeletons into goddesses” and teaching our children and impressionable young people to hate their own bodies. That is why I am so grateful to the hon. Member for Romsey and Southampton North and members of the all-party group on body image for their tireless work in addressing the causes and consequences of body image anxiety. Through the Government Equalities Office, the coalition Government are conducting our own body confidence campaign, with three main aims: to raise awareness about body image and encourage a more open and public conversation; to promote a world where all healthy body shapesare represented, and people recognise that their value is far more than merely their physical appearance; and to widen the definition of beauty to include all ages, ethnicities and healthy sizes.

Pro-anorexia and pro-bulimia websites, which were mentioned by the shadow Minister, the hon. Member for Romsey and Southampton North and others, have grown significantly in recent years and are represented on sites such as Facebook. They do not cause eating disorders, but they play a significant role in exacerbating and reinforcing illness. Limited research is available, but what there is shows us that a significant number of teenage girls in particular visit such sites, including a substantial proportion of young people who already have an eating disorder. Disturbingly, nearly all of them report learning new weight-loss techniques from the sites. I am extremely concerned about those sites but cannot take legal action against them as they are not in themselves illegal and might also be hosted overseas, but we continue to explore other, non-legislative courses of action. For example, we recently worked with a media agency to run advertisements directing youngsters to more appropriate sites, because there is much good information out there on the internet, as well as dangerous sites.

A couple of weeks ago, I met security companies such as McAfee and Symantec, and urged them to work with groups such as the Samaritans, Beat and BeatBullying, as well as internet service providers, and to sign up to a concordat, speeding up the reporting of harmful content and blocking harmful websites. They told me they would explore such a concordat. In turn, the Government would be willing to facilitate and support such an initiative in any way we can.

We cannot place all the blame at the feet of the media. That would dramatically underestimate the scale and nature of the problem, but it is something we must challenge. Education and early intervention, keeping an eye out for symptoms, and providing relevant support are simple things that can dramatically increase the chances of recovery.

Sufferers have asked us to listen. My message to them is that we are listening. As I said, I have had personal experience from my work in Norfolk of the horror of this condition and its impact on families. While I am in this job, I want to do everything I can to help others to address this very serious problem and to improve the lives of those who are affected by it.

[Caroline Nokes]

I welcome the opportunity to summarise briefly. We have had a full and interesting debate. I pay particular tribute to my hon. Friend the Member for Basildon—I am sorry, I mean Braintree (Mr Newmark). I am trying to send him to a different part of the country. Everywhere in Essex begins with B! His contribution was fantastically personal and moving. I am convinced that many other hon. Members in the House have had personal experience of eating disorders in their families or personally, and we must, as the Minister said, take such disorders more seriously. I was delighted to hear his words this afternoon about his personal commitment while he remains in his job—long may that be so.

I thank all hon. Members who spoke. Many were unable to be here for the full time, but they came and went. Two important debates are taking place in the House this afternoon, which were also granted by the Backbench Business Committee, so I am conscious that we have been competing with others for parliamentary time and attention. I want to take this opportunity to reiterate some of the key points that we have made.

There must be continuity of care. We heard the important point about the transition from child services to adult services, and how some sufferers can fall through the gap. Equally, that transition, whether from school to college or college to university, may be a tipping point for those who suffer eating disorders when they need continuity of care. My strong argument to the Minister is that there must be flexibility in both specialist services and GP services so that if a young person moves away to university, there is joined-up thinking and treatment, and no moment of crisis when a young person does not get the care they need.

We have heard from hon. Members about the impact of eating disorders on male sufferers. They are the fastest-growing group, but that does not detract from the fact that clearly the majority of sufferers are women, and the vast majority are young women.

One stark statistic that I want to close on is that 20% of anorexia nervosa sufferers die from that condition. We must do more to ensure early intervention so that that number falls.

I thank the Minister for his time, and you, Mr Walker, for chairing the debate. I also thank all hon. Members who took part this afternoon.

[Mr Charles Walker (in the Chair)]

Thank you, colleagues, for such an informative debate, which was Parliament at its very best.

Question put and agreed to.

Mental Health Care (Hampshire)

Caroline Nokes Excerpts

Wednesday 18th April 2012 Westminster Hall

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

I pay tribute to my parliamentary neighbour and hon. Friend the Member for New Forest East (Dr Lewis), not only for the outstanding work he has done to highlight this important issue, which is of grave concern to his constituents and to many residents of southern Hampshire, but for his tireless work to analyse bed availability within the Southern Health trust area. From what he has told us this morning, there can be little doubt that the work done to analyse and challenge the statistics of bed usage, including the somewhat confusing question of what is an available bed and what is simply a leave bed, has taken a great deal of time.

What many of my constituents and other local residents want is to make sure that the outcome of the process is correct for local users of adult mental health services. As my hon. Friend has correctly indentified, this is not an argument about the philosophy of how best to care for those in need. There will always be a need for acute in-patient beds, although we certainly believe there is potential to improve arrangements and thus avoid in-patient admission for those who can be successfully and safely treated in the community. However, what has not been clarified throughout this process is the number of beds that there are in the system and the number of beds that are needed. My hon. Friend has certainly done sterling work over the past few months analysing bed usage, and I do not intend to repeat any of those statistics—we have heard in great detail what may or may not be available. Suffice it to say that, in the past six months, there have been many occasions when there have been no vacant beds across the service.

On top of that, there are many valid questions from service users in my constituency about the choices made about which beds should remain available in the locality. At the start of the year, I attended a meeting organised and hosted by my hon. Friend to learn more about the concerns of local service users and to hear at first hand how important the provision at Woodhaven is to local people, their families and their carers. Given the location of Woodhaven and the distribution of mental health beds across Hampshire, it is inevitable that this closure will impact on not only the constituents of my good Friend, but those of several Members across southern Hampshire. As my right hon. Friend the Member for New Forest West (Mr Swayne) has indicated, mental health problems are no respecter of, and trust boundaries are not contiguous with, constituency boundaries.

Of course, when discussing reconfiguration of health services, frequently the focus is on location, and service users will emphasise the distance of travel to get to a facility, the availability of public transport and how convenient it is for loved ones to come and visit. Interestingly, when discussing Woodhaven, that was not the message I received from service users or their families. Indeed, if we were to analyse the journey times and the ease of access, it is possible to argue that, for the vast majority of my constituents, Woodhaven is simply not as accessible as alternative provision at Melbury Lodge in Winchester. Woodhaven is a great deal further away for many people, and the public transport links are much poorer.

However, location has simply not been the focus for any of my constituents who have had experience of either Woodhaven or Melbury Lodge, or indeed both. Far from emphasising convenience, my constituents’ concern has been regarding the quality of provision. The questions they have posed have been eminently sensible. Why is it proposed to deprive acutely ill patients of the benefit of 24 modern en-suite beds that were opened only eight years ago? Why would the trust choose to keep the facility that is not as good, that does not afford the same level of privacy and dignity and that has no en-suite facilities at all? I would like to highlight the comments made to me by just two constituents who have contacted me. The first wrote:

“My wife has been an inpatient at both Woodhaven and Melbury Lodge. Melbury Lodge isn’t anywhere near the standard of Woodhaven. Woodhaven is very pleasant, with a lovely atmosphere. Melbury Lodge by comparison is very intimidating with a lock down high security approach. This may be appropriate for some of their patients but for the majority it’s just scary.”

The second constituent provided me with a very detailed account of his mental health issues, a suicide attempt in 2008, and his own stay at Woodhaven under section. He wrote:

“Having been an inpatient at Woodhaven I would emphasise the privacy. Having a breakdown surrounded by others who do not respect your privacy is very difficult. When I was in acute crisis I desperately needed short term care and support, it would be a disaster for local service users if those high quality short term beds were lost in favour of a less good facility, or worst case scenario, no bed at all.”

I pay tribute to one of my hon. Friend’s constituents, who made a lasting impression on me at the meeting mentioned earlier. He had been an in-patient under section at both Melbury Lodge and Woodhaven and, again, it was the privacy aspect he emphasised. While an in-patient at Woodhaven, he felt he had retained his dignity by being able to have his own bathroom. That clearly made an enormous difference to him personally, and I think we can safely draw the conclusion that a feeling of having some personal space and privacy can greatly improve the overall sense of well-being and aid the chances of a swifter recovery.

I have absolutely no doubt that the facility at Woodhaven is of an extremely high standard; we know that from the comments made by consultant psychiatrists. We know that the demand for short-term acute beds is high, and that one in four of the population suffers from some level of mental health problems at one time or other during their life. We also know that the NHS trust’s figures on bed usage and length of stay at the unit have been called into question. Is now the right time to press ahead with a closure, or is it timely to call a pause to the process until such time as the disputed statistics have been independently analysed?

Ovarian Cancer

Caroline Nokes Excerpts

Wednesday 12th October 2011 Westminster Hall

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

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing the debate. I want to focus on a small area of it, but first I pay tribute to the hon. Member for Slough (Fiona Mactaggart), who gave us a very personal story and identified a key problem—the complexity of the symptoms, the fact that they are sometimes confusing and the general lack of awareness of what they are.

I thank Target Ovarian Cancer for its approach to me, which was quite personal. It was one of those approaches, which I sometimes receive, that make me think, “Ouch!” It would have been great if I had been approached by the Teenage Cancer Trust to be asked to emphasise the number of very young women who suffer, but, unfortunately, as I am approaching a large birthday, Target decided that I was in the key target group of women who really should know more. That is a key point. When I added in some other risk factors, such as lifestyle and weight, I began to scratch my head and think that perhaps I should take it all very seriously and think more closely about the symptoms that present when someone is suffering from ovarian cancer.

Despite the fact that women tend to be more aware of symptoms and keener than men to go to the GP—I apologise, as there are many male MPs present in the Chamber—they also have a serious tendency to grin and bear it, and get on with things. Sadly, symptoms such as bloating are not uncommon. I see the hon. Member for Slough nodding in agreement.

We are missing an opportunity, because by the time women get to a significant birthday they are already well used to some forms of screening for cancer. Great, next year I get mammograms as well—fantastic. That is an opportunity to talk to women about the symptoms of ovarian cancer. I do not want to appear controversial or to denigrate the idea that we need a general awareness campaign, which is important, but as any good advertising company will explain, a targeted message to the audience likely to be most affected is the best way to get something across.

I suggest to the Minister that we need to look at ways to approach the women most likely to be affected. That is not in any way intended to undermine the work of the Teenage Cancer Trust. The incidence in younger women is important and alarming, but age, genetics and hereditary disposition are the largest contributory factors in ovarian cancer, and we need to give close attention to the idea that when women are called for routine cervical smear tests or mammograms they are in exactly the right caring, knowledgeable environment for explaining the symptoms. I hope that the message will get out a little more effectively to those women who are at risk and who could contribute significantly to the Government target on reducing deaths from cancer.

Congenital Cardiac Services for Children

Caroline Nokes Excerpts

Thursday 23rd June 2011 Commons Chamber

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

I add my congratulations to my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate. I thank the Minister for his important comments on, and support for, the motion.

I feel strongly that there should be a change in the configuration of children’s cardiac surgery, but it must create the right configuration. We want the correct answer to the question, and we want the review team to listen to all the arguments and make its decision based on the best possible evidence. I argue strongly, representing as I do part of the city of Southampton, that when we are looking at the important issue of children’s cardiac surgery, we must base our decision on quality.

I have been in regular contact with a constituent of mine, Mr Jim Monro, whose name will be familiar to all Members who have investigated this matter because he is one of the country’s most eminent cardiac surgeons. He is now retired. He first conducted a review into children’s cardiac surgery after the tragedies in Bristol in the 1990s. He feels strongly that he has seen this matter kicked into the long grass for too long. We must crack on and ensure that the review is completed. However, it must take into account the best available evidence and come up with the right outcome. None of us wishes to see a recurrence of the dreadful tragedies in Bristol. That is where the roots of the review lie.

Although I support the need for the review, I do not endorse the process, nor the recommendations in their entirety. I question three elements in particular. Fundamentally, the review must be about quality. We have to ensure that the best outcomes are achieved for the very sickest babies and children. However, the Southampton unit, which has a superb record of outcomes, finds itself in only one option—option B, the so-called quality option. I cannot believe that that is right for one of the highest performing units in the country. It carries out difficult procedures, does not cherry-pick cases where the best outcomes are likely, has proved that it can work collaboratively with Oxford, is widely acknowledged to be one of the best units in the country, and already has three surgeons, with a fourth starting shortly. I have heard colleagues describe it as a perverse outcome that one of the country’s top performing units is included in only one option, in which postcode matters more than the life chances of the sickest babies.

Secondly, and I will not rehearse this argument at great length, there is the additional complication of the Isle of Wight. My hon. Friend the Member for Isle of Wight (Mr Turner) has informed us of that issue clearly. People from Southampton want an answer to that question. Six weeks ago at a consultation meeting, they were promised that more information would be forthcoming from the review team about how significant the Isle of Wight factor was. We are still waiting.

Thirdly, the manner in which the consultation is being conducted has created an adversarial climate in which cardiac unit is put against cardiac unit and surgeon is put against surgeon. I feared that today we would see MP against MP, but we have not. As my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) said, this has been a collaborative debate that has picked up on the strengths of each case.

I welcome the spirit in which this House has responded to the motion.

Oral Answers to Questions

Caroline Nokes Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Anne Milton]

I point out to the hon. Lady that with the new commissioning consortiums, those decisions will be made at a much more local level. Only 36 of 152 PCTs are currently contributing to the helpline, which is nonsense when one considers that they are being asked for only £422 each. It is right that such decisions should be made locally, particularly in view of the sort of emotional support that the helpline can give.

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

14. What steps his Department is taking to increase the provision of preventative health care.

[The Secretary of State for Health (Mr Andrew Lansley)]

In addition to what I said in reply to Question 3, I can tell my hon. Friend that we will shortly be publishing a public health White Paper, which for the first time will not only demonstrate a commitment across Government to improving public health and reducing health inequalities, but introduce a strategy and implementation programme to achieve precisely that.

[Caroline Nokes]

I thank my right hon. Friend for that answer. Chronic obstructive pulmonary disease is responsible for 30,000 deaths a year, and it is the second largest cause of emergency hospital admissions in the UK. In response to the consultations that have been received from, among others, groups in my constituency, will the Secretary of State please tell me when the Government plan to publish the clinical strategy on COPD?

Contaminated Blood and Blood Products

Caroline Nokes Excerpts

Thursday 14th October 2010 Commons Chamber

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

I thank the hon. Member for Coventry North West (Mr Robinson) for opening this debate and all the Members who have spoken in it thus far. Many of them mentioned by name constituents who have suffered as a result of receiving contaminated blood products, but on Monday I received a visit from a constituent who specifically did not wish to be named because she still feels that she suffers a stigma as a result of having hepatitis C. She does not want it talked about and she is embarrassed, but it is not just she who suffers; so, too, does her son.

There is never a good time to get a Government to commit to significant spending, but this is a new Parliament with a bright, shiny new Government and we should celebrate the fact that we finally have the opportunity to hold this debate on the Floor of the House of Commons some 20 years after the subject under discussion became an issue.

Not many people in Romsey and Southampton North have been infected as a result of having received contaminated blood products, but a handful have, and it is tragic to hear some of them say that although they would like to be present today they do not feel they can afford the train fare to come to London. Indeed, even those who have travelled have welcomed the fact that the debate is being held in the afternoon so they do not have to pay peak-time train fares to attend it.

I wish to make a specific point to the Minister, but let me first say that I welcome parts of the written statement, because elements of it represent progress, and the people in the Public Gallery who have travelled here today want to see progress on this issue. They do not want a partisan row to develop on the Floor of the House; they want us to make moves in the right direction.

One constituent who came to see me made some points about insurance. She and her family find it difficult to enjoy a family holiday because it is hard for them to get travel insurance. There are similar difficulties with life insurance and mortgages, and therefore it can be hard for people to buy their own property and have the security that that provides. I therefore welcome the parts of the statement that make reference to insurance because it is important.

The specific point I wish to make is about dentistry. It may not be particularly widely known that hepatitis C sufferers frequently have significant problems with gum disease. A constituent of mine therefore wanted to have easier access to NHS dentistry. I hope the Minister will take that point on board, and be prepared to make some sort of dentistry provision in future.

My constituents are not greedy people. Both those who have travelled here today and those who have not have stressed to me that they wish there to be fair compensation, and that they wish to have help from this Government. They do not wish to apportion blame because there has not been any progress over the past 20 years. What they want is progress now.