Tobacco and Vapes Bill

Chloe Smith Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Chloe Smith (Norwich North) (Con)]

Fifteen years of experience of leading and scrutinising complicated legislation tells me to be cautious with the Bill. I strongly admire its aims, but I have some questions to set out as to whether it will work.

With direct knowledge of cancer and deep commitment to cancer awareness, I want people to smoke less. As we have heard, smoking causes around one in four of all UK cancer deaths. Tobacco, especially cigarette smoking, is the single most important and, as we have heard, preventable cause of ill health, disability and death in this country. I agree with the Bill’s hope of reducing that suffering. I also desire the Bill’s aim to realise an economic saving on healthcare, named as more than £3 billion in the impact assessment, and a productivity gain of £24 billion over 30 years. My hon. Friend the Member for Winchester (Steve Brine), the chair of the Health Committee, is right that we should be taking the long-term view and looking for the gains from prevention. For all that to be possible, however, the legislation has to work.

I am joining today’s debate—I shall keep it concise, Madam Deputy Speaker—because I care very much about politics and democracy working. As I stand down from Parliament this year, this is one of the final pieces of draft legislation for me and it is a significant proposition, so I will raise some points that are all intended to be thoughtful and are based on five terms of constituency work and ministerial experience in six Departments. In one of my past roles, I had to undo legislation that I had helped to implement, because it did not work.

The age-of-sale mechanism in the Bill is the untested thing. It would be the first of its kind in the world, but that accolade would come only because a few have tried and failed to carry support. The Bill as a whole has an imperfect evidence base—that is clear throughout its analysis, in particular because we do not yet have the full data picture about the effects of vaping—so what is in front of us today is inherently risky and theoretical. It is also possible that it may be divisive by asking one group of adults to live under rules different from those for another. I understand that the Malaysian equivalent was challenged on equality grounds and I would be really interested to know what lessons the Minister has drawn from that.

It is legitimate to be worried that something so novel may be unfair on retailers. The British Independent Retailers Association points out that the quite sophisticated enforcement needs of the mechanism fall on its members. As the Association of Convenience Stores adds, the

“proxy purchasing of any age-restricted products is extremely difficult for retailers to detect and prevent.”

Indeed, the deterrent in the Bill for proxy purchasing is just £50, if a person caught and pays promptly. After my right hon. Friend the Chancellor’s efforts at the latest Budget, that is actually only the cost of about two or three packets of cigarettes. I am therefore concerned that the design of the proxy-buying deterrents in the Bill could be fatally impractical for what is trying to be achieved. Let us put that in really super-practical terms. A person’s friend, a year older, may well be able to go into a shop or online and get two packets and let their friend have one, and the cost of their doing so adds up in the end to only three or four packets for themselves. We ought to give considerable thought to that.

The British Retail Consortium says that a better policy is needed on ID. I agree. I was surprised that the impact assessment says nothing about the impact of individuals needing to provide ID throughout their life, instead of just up to the age of adulthood. The document, of course, does deal with the costs to retailers of checking ID, but it is silent on the burden of asking a particular group of adults to have to prove their date of birth for life. I am talking about those who are or look, and would continue to be or to look, just above the age stated in the Bill. Healthy or unhealthy, right or wrong, they have every right to buy cigarettes and would remain in possession of that right, but they would have to prove it for life under the Bill.

When I took the Bill that became the Elections Act 2022 through the House, we were rightly questioned hard about the notion of asking adults to bring identification to polling stations. We acknowledged up front that not everyone holds a driving licence or a passport, and ensured that other forms of ID were available, given the importance of people’s democratic rights. This is a slightly different point and I am not making a direct comparison, but for the purposes of retail, free ID—for example, the CitizenCard—is already available. However, it needs to be renewed every few years, and a new requirement in the Bill means that it would need to be used for life. I think the Government should have more reassurances to give law-abiding people than silence.

I said that I strongly admired the aspiration of the Bill. For the sake of all those who are entangled in a lethal addiction, I would like to see smoking stop in this country, so I am not standing here on ideological grounds. I am making sensible points about whether the Bill is going to work. We have had—rightly—a wide-ranging, reflective and constructive debate, but good intentions and heroic ambitions are not enough. If we are to do something very novel and use the power of legislation to do it, we need to have confidence that the legislation is workable. I hope that my fellow legislators will rise to the challenges that are presented by this idea, and will scrutinise it carefully.

Oral Answers to Questions

Chloe Smith Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

I pay tribute to the hon. Lady for the work she is doing in this space. I was in the Chamber when she presented her Bill last week and I can reassure her that, as part of the work we are doing with integrated care boards, we are collating and publishing data on the commissioning of fertility services, so that women in each part of the country can not only see what services are available to them, but compare what is being offered locally. That is happening in England; I cannot comment about what is being done in Wales. Let me also say that the Human Fertilisation and Embryology Authority is publishing data about add-ons, which I know is a particular interest of hers. We want to make sure that that information is available on the NHS, so that women can make an informed decision.

[Chloe Smith (Norwich North) (Con)]

I welcome that update, and the tone and, as always, the calm confidence with which the Minister provides it. Does she agree with me and with the Chancellor that the NHS has to help people back into work?

[Maria Caulfield]

I thank my right hon. Friend for her kind words. I absolutely agree on that, which is why helping women back into work and dealing with their health issues in the workplace is one of the first eight priorities of the women’s health strategy. We are working with colleagues in the Department for Work and Pensions on that. Last night, I had a roundtable with tech and STEM— science, technology, engineering and maths—employers, and they were desperate to keep their women in the workforce and to recruit more. Whether we are talking about young women who need support as they go through endometriosis or IVF treatment, or older women who are dealing with the menopause, we are absolutely committed to supporting women’s health needs in the workplace.

Oral Answers to Questions

Chloe Smith Excerpts

Tuesday 1st November 2022 Commons Chamber

[Will Quince]

I thank the hon. Gentleman for his question. We remain absolutely committed to growing and supporting our vital NHS workforce. In addition to the work already in place to continue growing the workforce, we have, as he mentioned, commissioned NHS England to develop a long-term plan for the workforce, looking at the next 15 years. It is important that we do that in tandem and I will have conversations—I think later this week—with my counterpart in the Scottish Government.

[Chloe Smith (Norwich North) (Con)]

Workforce does matter enormously to backlogs and cancer backlogs in particular. I have come here straight from a mammogram two years after being diagnosed with breast cancer. Luckily, I am in rude health. [Hon. Members: “Hear, hear.”] However, for my constituents, the Norfolk and Norwich University Hospitals NHS Foundation Trust has met cancer referral targets only once in the last three years. Staff are working extremely hard, including by running more clinics and scaling up services. Will the Minister support the trust to reduce waiting times for my constituents for tests, results and treatment?

[Will Quince]

I thank my right hon. Friend for her question and I look forward to visiting Norfolk and Norwich University Hospital as soon as possible. She rightly raises cancer referrals. Cancer referrals from GPs are now at 127% of pre-pandemic levels. Cancer treatment levels are at over 107% of pre-pandemic levels, with nine out of 10 people starting treatment within a month. However, as she rightly points out, there is variance across the country and, where trusts have more challenging statistics, we need to address them.

Brain Tumours

Chloe Smith Excerpts

Monday 18th April 2016 Westminster Hall

[Chloe Smith (Norwich North) (Con)]

It is a pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and the many others who have spoken eloquently in this debate. I have just a few small points to add to what has already been said. I have personal experience of brain tumours—the first time I became aware of death was when the younger brother of a close friend at primary school passed away. People often learn to talk about such things with a fellow child.

I want to speak on behalf of two constituents today. The first, Daniel, is in his 20s and is a very capable young man in the community. He set up a local youth club, and he is now involved in making a film about his experience of living with a brain tumour. He has explained to me that the biggest issue for him is the lack of available drug options. He would like to see more research into non-chemotherapy drugs.

Another family in my constituency who made contact with me in advance of the debate is Colin and Joyce. Their daughter Jennifer died 10 years ago due to an undiagnosed brain tumour. Today, I am sad to report, would have been Jennifer’s 32nd birthday. They have asked me to raise in particular the need for equity of access to speedy diagnostic tests, on a par with common cancers. They believe, rightly, that guidelines backed by robust research are needed to educate medical and healthcare professionals, as well as the general public, on the range of symptoms that can indicate brain tumours. The Bell family, also rightly, ask for better research into new treatments, access to clinical trials for new treatments and—this is crucial—rehabilitation therapies to improve quality of life.

The Bells are impressive in so many ways, because they lead the Norfolk Brain Tumour Support Group. I want to emphasise to people in Norfolk that that support is available to them. At the support group, I met some nurses from the Norfolk and Norwich university hospital, as well as patients. The nurses told me about not only the difficulties of diagnosis, but the complexities of treatment. The treatment pathway can be complex from the perspective of the patients and of the nurses and doctors, and there are also challenges post-discharge. In the words of the Bell family, to achieve a better future,

“charities, the NHS, educational and research institutes must work together and communicate effectively. This is crucial to make the best of available resources in the current economic climate.”

Joyce and Colin Bell

“very much hope that the debate will result in increased funding being made available to improve outcomes for people affected by brain tumour”.

I strongly agree with my constituents. We must make the best use of support groups, such as our local one, and of symptom advice, such as that of HeadSmart. Ultimately, however, we must look to see whether we can do anything better in diagnosis, on the pathway once people are under care, and for their needs post-discharge.

Contaminated Blood

Chloe Smith Excerpts

Tuesday 12th April 2016 Commons Chamber

[Chloe Smith (Norwich North) (Con)]

I am very glad to be able to take part in this debate, having secured it along with hon. Members from both sides of the House. It is on an important and sombre topic.

Back in 2015, I spoke in this House on behalf of two constituents. One is, I believe, in London today. One has passed away—Annie Walker of Norwich. She was one of thousands of people nationwide given infected blood by the NHS during those decades. It left her fighting illness throughout her adult life—she contracted hepatitis C from an otherwise routine blood transfusion at the age of just 19. That caused cirrhosis of her liver and led to cancer in later years. Despite a liver transplant in the months since I last spoke for her in the House, she was told that the cancer had spread and was given just months to live. Like many others, throughout her illness she campaigned to increase hep C awareness and for better treatment of those affected by the scandal. The first thing I want to do is to pay tribute to her courage and tirelessness in campaigning for others while she was suffering so badly herself.

I will add just a few points to the arguments that have already been raised, urging the Minister to do everything she can to put right this historical wrong. I urge her to look again at indexing. It is important to maintain the value of the payments made to those who are suffering. I also urge her to stick to her guns and make future payments simpler and more dignified, rather than people having to go cap in hand to a motley collection of charitable funds.

I urge the Minister to stick to what she laid out in this House, when she established her aim to get annual payments to those who had not, to date, received them. There are those who have not yet been included in the funds and they currently receive no regular support. It is good to seek to include some of those people in the scheme. Her other aim—not to remove payment from any person—is equally crucial. She has set out her aims to the House and we will all hold her to them. Like other Members, I welcome the doubling of the funding available through the NHS. I also welcome the action the Minister has laid out in relation to treatment, something I have argued for a number of times.

A third constituent came to see me after we last held a debate on this matter. He suffers from severe cirrhosis of the liver and needs the new generation of drugs. We should make those drugs available as soon as possible for those who could suffer less. The dreadful dilemma for doctors is whether they should treat the sickest first or those who could be prevented from getting sicker. I welcome the opportunity the scheme represents potentially to prevent that dreadful dilemma in doctors’ surgeries and hospitals.

It is a very delicate matter to argue about who, among those who need treatment, should be prioritised. Unfortunately, that is exactly what we have to do in this place on behalf of our constituents. Doctors have to make such decisions every day. On balance, I think it is right to seek to fast-track those who are in the early stage of disease. The dreadful dilemma could perhaps be stopped, given such a historical wrong done to our fellow human beings. I could not possibly look the third constituent of mine in the eye and say that today I argued against possibly stopping that dreadful dilemma by arguing against the Minister’s proposal. She is doing a courageous thing with that particular proposal.

In closing, I want to return to my constituent Annie Walker who has passed away. I supported my constituent and corresponded with her over many years. My heart goes out to the family and friends she leaves behind. Every individual death emphasises the tragedy of this scandal. It is a national scandal and a national tragedy. The fight must go on. Annie fought that fight during her lifetime, with my support. Many who have spoken today and the many who are able to be in London today are also fighting the fight. I urge anybody affected who has not yet come forward to do so and to look at the consultation before it runs out in a few days. We in this place can only attempt to get this right if we have information from those affected. That is our job.

[Clive Lewis (Norwich South) (Lab)]

Does the hon. Lady agree with the sentiments of my constituent Steve Bertram, who I believe is here today, who came to my office last week? He has a face that many would recognise. He looks like someone who has been repeatedly kicked in the teeth. He said:

“Our government needs to act for English Haemophiliacs – generously and properly. Like me, I hope anyone who responded to the consultation told the government in no uncertain terms how paltry, mean and demeaning the offer is.”

[Chloe Smith]

I will let the words of a fellow Norwich person speak for themselves. I am glad that the hon. Gentleman has been able to vocalise them for his constituent.

It is up to us in this place to get this right and to listen to all such points carefully. Annie Walker once said to me that she did not have the strength to keep on fighting. Sadly, that has now come true. It is up to us to continue to speak out. It is up to us to right this historical wrong. It is up to us to do that with both finance and NHS treatment. I urge the Minister to listen carefully to what has been said today, but to listen even more carefully to the consultation.

William Mead: 111 Helpline

Chloe Smith Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I understand what the right hon. Lady is saying, and of course I would listen to her because of her experience, but I reassure her that that is not the only thing that we are doing; we are doing lots of other things. The report makes many recommendations, one of which is to look at the algorithms that the call-handlers use to make sure that they are more sensitive to some of the red-flag signs of sepsis, meningitis and other conditions. There are lots of other recommendations. They include earlier access to clinicians where appropriate, and recommendations on the training of clinicians in the out-of-hours service, the training of GPs and the training of people in hospitals. So we will be undertaking a much bigger body of work as a result of this review.

[Chloe Smith (Norwich North) (Con)]

I welcome my right hon. Friend’s commitment to support CCGs to commission the 111 service and the out-of-hours service together where appropriate. He may be aware of some concerns in Norfolk about our out-of-hours service. What else is he doing to recruit, retain and support GPs in providing the round-the-clock care that people clearly need?

[Mr Hunt]

I have said before at this Dispatch Box that successive Governments of both parties have under-invested in general practice, and that is part of the reason why it takes too long for many people to get a GP appointment. It is why we have said that we want to have about 5,000 more doctors working in general practice by the end of this Parliament. That is an important part of what we want to do.

The other side is improving our offer to the public. When you have a child with a fever, and you are not sure, and it is the weekend, very often you have a choice between an out-of-hours GP appointment, a weekend appointment at your GP surgery, calling 111 or showing up at an A&E department. It is just confusing to know the right thing to do. If we are to improve standards of care, we need to standardise safety standards across the NHS, including for spotting potential sepsis cases, and that means a much simpler system.

Infected Blood

Chloe Smith Excerpts

Thursday 21st January 2016 Commons Chamber

[Jane Ellison]

Let me first thank the hon. Lady for all the campaigning work that she has done, for which she has rightly been recognised by others. Although we have not always been able to agree on everything, I have been greatly informed by what she has brought to our discussions, and I take on board many of the reports that the all-party group has produced over the years.

The recommendations that are being discussed in Scotland were made by a reference group and not by the Scottish Government, who have yet to respond to them. Shona Robison indicated that they would respond in due course, but that, obviously, is a matter for them.

It is a little too early to specify exactly how the individual health assessments will be carried out, but we will be asking an expert advisory group to advise on the criteria and the evidence. As I said in my statement, it is a question of recognising the impact of ill health, and also the fact that some people’s health fluctuates. I think that we can be assured that everyone will be included in the scheme, and that everyone will receive an annual payment. I should add that we expect people’s own clinicians to be involved in the individual assessments.

[Chloe Smith (Norwich North) (Con)]

I welcome the Minister’s personal determination to see this through, and the progress that she has already achieved. I know we all agree that it has long been needed. I welcome the Government’s apology, the level of funding that has been secured, the format of the annual payments, and, in particular, the backdating offer. However, may I also urge the Minister to focus on fulfilling her promise of treatment for hepatitis C at every level of the NHS? A great deal of bureaucracy lies ahead, and our constituents have no appetite for putting up with it.

[Jane Ellison]

I thank my hon. Friend for what she has said. I am glad that she feels that we are making progress.

The NHS is just beginning to roll out many of the new hepatitis C drugs, although some people have already been treated, and obviously many more will be treated in the future. One of the benefits of individual health assessments for everyone in stage 1 of the scheme is that we shall be able to understand not just clinical need, but problems such as those described by my hon. Friend. The consultation may help us to establish whether help with navigating the health system is one of the non-financial aspects of support that people might seek.

Victims of Contaminated Blood: Support

Chloe Smith Excerpts

Wednesday 16th December 2015 Commons Chamber

[Jane Ellison]

As I have already said, I of course regret the delay. This is a very complex area. I appreciate the tone with which the shadow public health Minister responded, because, as he said, Governments of all colours have not turned to this issue. We have turned to the issue and we are addressing it in a great deal of detail. It is a complex area. There is a very diverse range of affected groups impacted by this tragedy and we must get the consultation on reform right for all of them. I have been clear, in my response to the urgent question, that we have been considering the funding issue. We are, of course, aware of potential litigation in relation to the scheme as it stands. I cannot comment further on that, but the House will appreciate that that adds a level of complexity to dealing with this matter.

I am always extremely happy to come to the House to explain. The scheduling of debates in Government time is not a matter for me, but it goes without saying not only that I would be delighted to debate the matter but that I am happy to talk to colleagues, including shadow Front-Bench colleagues, privately or otherwise, about this matter. That commitment remains.

[Chloe Smith (Norwich North) (Con)]

I echo the spirit of these exchanges; we need to do this job fast and well. May I highlight the tragic circumstances of some of those affected, including a constituent of mine who has sadly got more ill as we have been debating the fine details of the scheme? There is no more time to lose.

[Jane Ellison]

That point is well made and very much on my mind. When I can say more about the shape of our proposed reformed scheme, I hope my hon. Friend will see that we have tried to respond to her concerns and those of many other right. hon. and hon. Members.

Mental Health

Chloe Smith Excerpts

Wednesday 9th December 2015 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it.

I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.

The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.

Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.

When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.

In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.

Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.

I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.

I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.

Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.

I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.

Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.

[Chloe Smith (Norwich North) (Con)]

I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?

[Dr Cameron]

I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.

Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

I welcome today’s debate. We are doing a very simple thing today, but it is very effective: we are again talking about mental health in this Chamber. Both the Secretary of State and my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) talked about a change in attitudes and said that things are changing. I agree totally that things are changing for the better, not just in this place, but in the media and in society. Sadly, in my own party there are some parts that still need to go a bit further in understanding mental health, but we are making great strides and they should be recognised. That is down to the great work that is being done by Rethink, Time to Change and other charities, which are not only those individuals who work for those organisations, but the thousands of volunteers behind them.

[Chloe Smith]

I hope the hon. Gentleman will welcome this intervention, because I seek only to give him the due credit that he deserves for his place in that all-too-brief history of our actually talking about mental health.

[Mr Jones]

I thank the hon. Lady for her intervention. I have a simple view on mental health, which is that we need to talk about it more, because that will change attitudes.

What do we do next? Well, we need to hardwire mental health and mental wellbeing into public policy and society. To those who ask why that is important, I say that not only is it the right thing to do, but, even in these times of austerity, it makes economic sense. It saves money as well as lives. We need a system in which every single Government policy is road-tested against mental health and mental wellbeing.

The Secretary of State accused my hon. Friend the Member for Liverpool, Wavertree of being political on this matter. Well, I am sorry, but the Government cannot escape from some of the things that they are doing in this area. It is the Opposition’s job not only to question the statements they make, but to look at the facts. The Chancellor announced an investment of £600 million in talking therapies, which I welcome, but that is set against a cut of almost 8.5% in the previous Parliament. The money will do nothing to replace the beds that have been lost in psychiatric wards. As the right hon. Member for North Norfolk (Norman Lamb) has said, there are people who have to travel ridiculous distances around the country to access those beds. What is the root cause of that? Is it a shortage of beds? Yes, it is in some areas, but another root cause, particularly in London, is the shortage of available housing. Our housing policy has a direct effect on the problem.

Another area of concern relates to the back-to-work interviews and the work capability assessments. My hon. Friends and I have raised that matter on numerous occasions, but the Department for Work and Pensions is not listening. People are still being put through that tortuous process, which is neither good for the taxpayer nor good for the individuals concerned. A 56% cut in the local government budget will have a direct effect on the delivery of mental health and support services. At the moment, a consultation exercise is out on the formula for allocation of public health funding. On that basis, County Durham will lose £20 million a year.

People might say that all those policies have nothing to do with mental health, but they do have a direct impact on the services that we deliver. We need to hardwire mental health and mental wellbeing into all those areas, whether it be schools, society, the family or the criminal justice system.

Many issues face people with mental illness. Personally, I have been to some very dark places, but the most tragic and darkest place is faced by those who commit suicide. We are talking about not just a life being cut short, and the opportunities that are missed in terms of the fulfilment that that person could give both to society and to their families, but families being left bereft and in a very emotional state. In this country, three times more people commit suicide every year than are killed on the roads. We had a great road safety campaign, which addressed the problem of people being killed on our roads. We need the same campaigning zeal to attack the suicide rates in this country.

My own region in the north-east has an unenviable suicide record. We have the highest rate of suicides in the country, with 13.8% per 100,000 individuals taking their lives. Such rates are related to the economic situation. People may try to gloss over that fact, but economic situations do affect people’s lives. We must also address the fact that 78% of that figure are men. Men are terrible at talking about mental health. So, yes, progress is being made, but we do need to have mental health and mental wellbeing running through all Government policies.

I welcome the debate today, because it provides us with another opportunity to talk about mental health on the Floor of the House, which must be a good thing. Now is the time to change those words into action.

--- Later in debate ---

[Chloe Smith (Norwich North) (Con)]

People deserve better service. For too long some constituents have battled to get the care they need. Many do get excellent care, and I pay tribute to the staff of the Norfolk and Suffolk mental health foundation trust, who dedicate their lives to caring for thousands of patients successfully. I am pleased to see the hon. Member for Norwich South (Clive Lewis) and the right hon. Member for North Norfolk (Norman Lamb) here. I hope they will work with me and meet the trust here next week.

What we should be debating today is how to complete the job of bringing mental health into the light, into equality with physical health and into an era where the norm is of a better service, with every patient getting the treatment they need. I am currently helping constituents who have lived with seeing someone they love go down in a spiral—fast, sudden, out of control and finding it too hard to know what to do. I am concerned about continuity of care, the role of GPs and out-of-county beds. Poor provision of services is not acceptable or just: people deserve a better service.

I want to say three things: first, funding matters; secondly, equality matters; and thirdly, good management matters. On funding, I welcome the steps that the Government are taking to increase investment. The Norfolk and Suffolk mental health foundation trust has been open about the funding shortfall it can see in its books compared, for example, with the Norfolk and Norwich hospital down the road. The chief executive has called for the same system of funding for mental health compared with physical health.

Of the seven CCGs in the region, Norwich devotes the highest proportion of its budget to mental health. Although the overall budget for this year rose by just over 6%, spend on mental health increased by just over 4%.

[Rehman Chishti]

Will my hon. Friend give way?

[Chloe Smith]

I am afraid that I cannot take an intervention.

Norwich CCG notes that its

“spend on mental health has increased significantly in real terms, by almost £2m.”

It believes that

“access to mental health care is consistent across the county in line with demand.”

I welcome the announcement today of transparency measures, which will help us to understand such a statement.

On equality, we need proper parity of esteem between mental and physical health to be made a reality through funding. It is welcome that, in the planning requirements, commissioners are required to invest additionally in mental health.

Finally, good management is also needed, as the Minister for Community and Social Care recently argued in the Eastern Daily Press. By the way, I pay tribute to its campaign on mental health. My trust is in special measures and subject to an improvement plan. We must work with the trust to help it to get better. The staff have made very clear the pressures that they perceive; I also pay tribute to them. The CCG found that the trust was good at caring, but inadequately led. Monitor found that its financial management was lacking. Patients deserve better and other trusts are doing better: Norwich deserves better.

[Several hon. Members rose—]

Oral Answers to Questions

Chloe Smith Excerpts

Tuesday 17th November 2015 Commons Chamber

[Chloe Smith (Norwich North) (Con)]

What support will be available to hospitals over the winter? Norfolk and Norwich University hospital declared a black alert last week.

[Ben Gummer]

We are preparing for the winter on an unprecedented scale, having learnt from the experience of last winter. Specific support has already been provided for Norfolk and Norwich University hospital, and support will be provided consistently throughout the winter to enable us to deal with the additional challenges that are, I am afraid, being thrown in the way of hospitals throughout the country by the junior doctors and their industrial action.