Health Visitors (England)

David Drew Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton]

My hon. Friend is absolutely right. I have met many health visitors. They are a fantastic resource and do huge amounts of good work well beyond their remit. They are frustrated by some of the processes and financial considerations that are stopping them from doing their job to the best of their ability with sufficient support.

[Dr David Drew (Stroud) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Tim Loughton]

This is the last intervention I will take, and I will finish shortly.

[Dr Drew]

One of the greatest frustrations is when families do not let the health visitors in, which is a growing trend. They come back time after time and they find there is nobody there or, if the people are there, they will not let them in. Does he agree that that is a very worrying development?

[Tim Loughton]

Earlier, I raised the contrast with social workers where there is a safeguarding issue. It is a completely different dynamic and relationship. There is a reluctance to let the social worker over the threshold. That is less the case with health visitors, because they are seen to be there to help. But there is a reluctance from some people, perhaps due to ignorance as to what the health visitor is there to do from people who think, “I know it all; I don’t need you,” or due to people who may fear that their vulnerability will result in their child being taken into care. That is why that friendly face is so important. The health visitor is on their side to help them in being a new parent, in a way that other professionals cannot be.

According to the state of health visiting survey by the Institute of Health Visiting, one in four health visitors did not have enough time to provide the post-natal mental health assessments to families at six to eight weeks, as recommended by the Government; the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that. These PMH checks are a key part of the Government’s maternal mental health pathway. Previous research involving clinical trials with 4,000 mothers found that those who received health visitor support were 40% less likely to develop post-natal depression after six months.

There are five mandated reviews under the healthy child programme that health visitors undertake. While those are spread across the first 1,001 days, they are concentrated in the first 12 months. Health visitors are concerned that the number of reviews is insufficient and leaves too large a gap between contact with families. Not enough scheduled reviews are happening, and we probably need more reviews intensively at those early stages.

There was also a lot of concern about steps being taken to help recruitment. I tabled a question earlier this week, which the Minister kindly answered. I asked

“the Secretary of State for Health and Social Care, what steps he is taking to reverse the fall in the number of health visitors.”

She replied in a written answer, saying that

“Since 2015, local authorities have been responsible for the commissioning of services for zero to five-year-olds and as such, they determine the required numbers of health visitors based upon local needs.”

We understand that. She continued:

“A Specialist Community and Public Health Nurse apprenticeship (Level 7) is currently in development. This will offer an alternative route directly into the health visiting profession.”

I am afraid that that answer raised some alarm among people at the Institute of Health Visiting, and the response to it that I got back was to point out that

“The apprenticeship route is not an alternative route directly into health visiting. Applicants still need to be nurses or midwives and the course presents a number of risks: it is longer, the end point assessment delays qualification unnecessarily…it does not deliver a national strategy for the profession. HVs”—

that is, health visitors—

“who are not employed by the NHS do not have the same opportunities to those covered by the NHS People Plan—this includes NHS funding for CPD”—

that is, continuous professional development—

“leadership development, pay rises, safer staffing and national action to address recruitment/retention difficulties.”

It also pointed out:

“Local Authorities determine the level of HVs dependent on local need, however there is no measure of quality of service or guidance on how far the service can ‘flex’ to meet those needs.”

In addition, the apprenticeship is still not ready to be rolled out; it takes longer than current training; and it is more costly and therefore less attractive to employers and/or recruits.

An urgent workforce plan is needed to tackle dwindling health visitor numbers. I have spoken to representatives of the Local Government Association. They are very concerned about this situation; as representatives of local government, they want to get their public health role right. The LGA said that

“it had offered to work with the Department of Health and Social Care, the NHS and Health Education England to help deliver a plan that would see the ‘right number’ of training places commissioned. It would also develop new policies to ensure health visiting remained an ‘attractive and valued’ profession.”

I hope that the Minister is receptive to that offer; I am sure she is.

What needs to be done? Again, we need to value the role of the health visiting profession. I am sure that all of us in this Chamber and beyond would want to do that, but we have to will not only the inclination but the means as well.

A publication by the Institute of Health Visiting, “Health Visiting in England: A Vision for the Future”, makes 18 sensible and practical recommendations, and they all involve some investment. I will touch very quickly on a few. The institute wants to see

“urgent and ring-fenced public health investment…A review of 0-5 public health funding…to cover the cost of delivery of the Healthy Child Programme in full in all Local Authorities in England.”

All local authorities in England will need that funding. It goes on to say:

“As we await the refreshed Healthy Child Programme, as an interim measure, the proposed metric should be a floor of 12,000”—

that is, 12,000 full-time equivalents—

“to restore the workforce to the target figure calculated for the Health Visiting Implementation Plan, 2011-2015…New National Standards for health visiting are needed to support consistency within the profession. The title ‘health visitor’ and its role should be protected and restored to statute. A review of health visiting training with a risk assessment of the impact of the removal of Health Education England funding of training and replacement by the use of the Apprenticeship Levy.”

Frankly, those are sensible measures. I very much hope that the Minister will look at them positively; I am sure she will. It would be a false economy not to do these things. They need to be part of a bigger shift in Government policy—the policy of any Government; I may be pushing at an open door—towards an earlier, more intensive, preventive intervention approach, from conception to the age of two especially. Health visitors are absolutely at the centre of that.

Electromagnetic Fields: Health Effects

David Drew Excerpts

Tuesday 25th June 2019 Westminster Hall

[Dr David Drew (Stroud) (Lab/Co-op)]

I am delighted to serve under your chairmanship, Mr Hollobone. My hon. Friend the Member for Gower (Tonia Antoniazzi) has done an admirable job in at least raising the issue that the precautionary principle should be paramount before we take on any new technology. As someone who represents a semi-rural area, let me say at the outset: please give me 3G. I am not worried about 4G or 5G; I just want 3G, with all the consequences it brings. My constituency still has at least one market town that cannot even get that. That was just a little plug for getting the existing technology in place.

What my hon. Friend says is worthy of debate. It should be taken seriously by the Government and should help the public to understand that their representatives are listening. Stroud being Stroud, an active campaign is already under way on 5G. People are saying, “We don’t want it and we’ll do anything to stop it, so please listen to those who have already raised concerns.”

Like my hon. Friend, I have met people who are incredibly affected by electromagnetic sensitivity—to the extent that, when they moved into their house, they had to have the smart meter taken out, and even asked their neighbour to take out theirs. Once that happened, their health dramatically improved. People say that electromagnetic sensitivity is all psychosomatic, but I have seen the evidence of people’s sensitivity to electromagnetic waves. If we ignore it, there will certainly be health and biological consequences, and there may be many more problems. Since my hon. Friend has done a valuable job of explaining the possible health and biological impacts, I will say more about planning.

It is only fair to ask the Government to at least respond to the growing evidence from the International Electromagnetic Field Scientist Appeal, PHIRE— the Physicians’ Health Initiative for Radiation and Environment—and other reputed scientists in the field, as well as from communities. Brussels has now stopped the roll-out, and so have a number of cities in California. There is growing concern, and it needs to be recognised and answered. It is a shame that we seem to be in complete ignorance of some of the effects of 5G. I have not seen proper medical studies that deal with people’s susceptibility to it. It would be right and proper for us to see those studies.

[Geraint Davies]

I apologise that I will have to leave before the end, Mr Hollobone.

Is my hon. Friend aware of the veracity of reports that 5G companies, which have enormous commercial power, have put pressure on the Government to move ahead quickly and are making threats similar to those made about the Transatlantic Trade and Investment Partnership? It may be that we have signed up already, and if we pull back on the basis of the precautionary principle and risks to human and wildlife health, the Government may end up being sued by big commercial interests. We should resist that in the interests of the public.

[Dr Drew]

I agree. My hon. Friend’s work on air quality is very important. Politicians in general are at last beginning to take note of the threats. It seems lamentable that, now that we understand the threats to air quality through pollution from cars, incineration and other things, another technology is coming in that could be as damaging. Maybe we will not see its effects for years, but will in decades unless we understand what it can do to people. It may not affect everybody—it may be down to genetic susceptibility—but we ought to listen to what is happening to those people.

It would be useful for the Government to put the studies, and their responses to them, on the record. As my hon. Friend the Member for Gower says, one problem is that, now we are into 5G, there is a view that existing masts can be added to or that additional technology can be used. I put it to the Minister that the biggest worry is that there is a view, certainly in Stroud, that lamp posts will be seen as a perfectly acceptable substitute and that, instead of putting up new masts, the technology could be added to existing infrastructure.

It would be useful to know what powers exist, because I understand that the electronic communications code has granted virtually unlimited powers to companies to construct, maintain or develop the current infrastructure without any planning permission. It is all done under delegated responsibility, which means that the general public do not even know what is going on, because normally these things are not publicised. There is little recourse unless the public take court action to stop it, but the means of doing so are limited. Even a private landowner has little authority to stop it. The matter needs to be looked into and properly investigated.

I ask the Government to look at how they can consult the public, because the public are getting worried. The scare stories may not have the full scientific rigour that they should have, but the public know no more than what they have been told by various experts in the field, and there are always experts on either side of the argument. Our case is that, at the very least, there should be an open, honest and transparent investigation of the health and biological impact of the new technology.

Driving forward 5G is about financial interests. It is not being done for altruistic reasons, but because an awful lot of money stands to be made out of it in a very short period. We need to look at that. It exacerbates the digital divide. As I have said, I would be satisfied with 3G my constituency.

Having listened to my hon. Friend the Member for Gower, I hope the Minister will be able to say what plans the Government have to investigate the impact on the ecosystem, which is as important as human beings. We need to keep our bugs, birds and other fauna in the state they are in, given that they are under enormous attack. We talked about that yesterday in relation to the climate change statutory instrument that we passed. We are not just talking about our own survival but the survival of other species. It would be a tragedy if we have done things to protect them and yet we let 5G come in. There are allegations that 5G has an impact on other species, particularly in rural areas where we see many living creatures.

My final point is that part of the problem is that the new technology is coming through without much questioning, or even recourse for people to question it. The biggest problem is the speed at which it is being introduced. There is no way that communities that are at best uncertain about the impact of that technology on their children, their schools and their wider community can do anything.

I ask the Government to look at this carefully, as my hon. Friend the Member for Gower said, so that we consider the implications both for individuals’ health and the wider ecosystem, and that we also take time and recognise that the precautionary principle is as important in this area as it is in general about air quality.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front-Bench spokespersons, the first of which will be from the Scottish National party.

Services for People with Autism

David Drew Excerpts

Thursday 21st March 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

rose—

[Dr David Drew (Stroud) (Lab/Co-op)]

rose—

[Huw Merriman]

I will take two more brief interventions, and then I will make some progress.

--- Later in debate ---

[Dr Drew]

May I pay my own tribute to the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan)? The hon. Gentleman is doing a very good job of reading her speech.

What parents find most frustrating are instances in which a care plan has been agreed and is in place, and the local authority then tries to renegotiate downwards the sum that has been agreed. That causes problems for the parents and, obviously, for the person with autism, but is also causes problems for, in particular, specialist units. Does the hon. Gentleman agree that that is unfair, and the wrong way to go about dealing with this whole problem?

[Huw Merriman]

I certainly do. The challenge is to ensure that care plans are flexible enough to be built on, while also including an element of prescription so that there is a proper guide. What must not happen is plans being effectively reneged on when care and support are still needed. The hon. Gentleman made his point very forcefully. He also said that I was doing a good job reading the speech; I will carry on doing my best.

I was talking about the impact on services, as my right hon. Friend the Member for Chesham and Amersham puts it,

“from education to adult support, from diagnosis to employment, transition to transport. We know the many ways that an autistic person may turn to the state—and to us—for support, and how vital it is to make sure it is there to meet their needs.

The last national strategy ‘Think Autism’ in 2014 included wide-ranging actions. This was underpinned with revised statutory guidance, setting out clear duties on councils and the NHS to deliver on these actions—but we know that many local areas are not meeting all of their obligations. There are also questions about whether the Act goes far enough. As we reach the 10th anniversary of the Act, now is an appropriate time to ask these questions.

The All Party Parliamentary Group on Autism, which I am proud to chair, is spending this year doing just that. We are holding an inquiry into what has worked, what happens now and, most importantly, what needs to change. We are looking very broadly, to reflect the needs of autistic people,”

including in health and mental health; children, education and transition; employment; access to justice; adult support; and public understanding.

Exiting the European Union (Food and Agriculture)

David Drew Excerpts

Tuesday 19th March 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I start by thanking the Minister for introducing these statutory instruments on the Floor of the House this afternoon and for summarising them so clearly for us. I would also like to start, as I always do, by putting on record once again my disappointment and concern that there could be as few as 10 days before we leave the EU, yet we are still dealing with crucial legislation concerning our food safety. The Government have run down the clock for more than two years and only now, when the deadline is so close, are we considering important legislation that could impact on the public’s health if we do not get it right. Of course, that is because the threat of no deal is still hanging over us. I know that the Minister wants to get this right, which is why I have supported him throughout the discussions on these SIs, but I am still disappointed at the way the Government have handled this.

These statutory instruments will transfer tasks and roles assigned to the European Commission and the European Food Safety Authority to an appropriate UK entity. Will the Minister please confirm who that appropriate UK entity will be? While we are taking these SIs as a group, which I welcome, I would like to raise some concerns about each of them in turn.

[Dr David Drew (Stroud) (Lab/Co-op)]

I am sure my hon. Friend agrees that this is as much to do with DEFRA as with the Department of Health and Social Care, and it shows why we need a food strategy in this country so that we can sort out some of the nonsense caused by the overlap between different Departments.

[Mrs Hodgson]

I absolutely agree. My hon. Friend makes a good point, and I discussed with the Government and Opposition Whips where responsibility for these SIs fell. There is so much crossover between food and health policy, and we are doing the best we can with the hand we have been dealt, but we should probably look more into this issue going forward.

Human Medicines (Amendment) Regulations

David Drew Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

I thank my hon. Friend. As the Member of Parliament for Cambridge, he works very closely with the life sciences and pharmaceuticals industries and is a great champion for them. He is quite right to raise those concerns—although it is not clear if we are leaving in 12 days because, as I said, the Minister at the Dispatch Box earlier was pretty hopeless in giving the House any clarity on that matter. I suppose we will have to wait for further statements from the Government tomorrow, unless the Health Minister wants to clarify matters for us in a moment.

One of the issues that the organisation my hon. Friend mentioned is concerned about is the parallel trade in medicines, where pharmaceutical exporters seeking to profit from currency fluctuations could see medicines intended to meet UK patient requirements being quickly distributed out to the EU because of the advantage that a fall in sterling, perhaps, could accrue to them in those circumstances. This is why we have seen widespread concerns about medicine shortages in the event of no deal.

[Dr David Drew (Stroud) (Lab/Co-op)]

This is not something just for the future. I am already getting reports that certain medicines are in short supply, and patients are being advised to go back to their GPs to see if there are alternatives because somebody somewhere is already stockpiling and there is not the flow through. Does my hon. Friend accept that?

Health and Care Professions Council: Registration Fees

David Drew Excerpts

Thursday 14th March 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I am grateful to my hon. Friend the Member for Coventry South (Mr Cunningham) for securing this important debate. I, too, had requested a debate on this subject but was unsuccessful, so I am pleased that he has been able to bring this important issue to the attention of the House.

Before I was elected to this place, I was registered with the Health and Care Professions Council, because I worked as a clinical scientist in the NHS. As we have heard, registration with the HCPC is an essential part of the job: without professional registration, scientists and allied health professionals in the NHS are not allowed to practise. I am no longer registered with the HCPC. Having worked for the NHS for 33 years and had a career change late in my working life, I have called time on my NHS career, so there is no conflict of interest.

The HCPC charging above-inflation fee increases is nothing new, but it is scandalous that its latest proposal is to raise fees for already hard-pressed healthcare professionals by an enormous inflating-busting 18%. If that increase is imposed, HCPC fees will have risen by 40% since 2014, outstripping inflation and going hugely above any pay rises that NHS staff have had.

I remember from my days in the NHS that the HCPC used to impose above-inflation fee increases during the years of the George Osborne 1% public sector pay cap. Any representations that the staff and trade unions made to the HCPC, at a time when many staff had had no pay rise at all, fell on deaf ears and were simply ignored. It appears that that has emboldened the HCPC to ask for more and more from its members, with no discernible improvement in the performance of the HCPC or an increase in the services that it provides to its registrants.

NHS staff are already struggling, their pay having been suppressed for many years since 2010, but more and more financial demands are made on them in order to stay in work. NHS staff in England have to pay to park at their workplace; NHS staff are paying more towards their pensions; any member of staff with any sense will be paying trade union subscriptions; many are repaying student loans; and now, they appear to be expected to finance the HCPC’s excessive, unreasonable and unjustified fee demands.

The staff are just not being listened to. My trade union, Unite, submitted a 38,000-signature petition against the fee increase to the chief executive of the HCPC before the decision was made on 14 February this year to increase its mandatory fees by 18%. It appears that the HCPC is quite happy to blithely ignore the voices of 38,000 of its members. Additionally, the HCPC consulted on increasing its fees from £90 to £106 a year and 90% of those who responded disagreed, yet that seems to have had no impact on the decision made on 14 February.

[Dr David Drew (Stroud) (Lab/Co-op)]

Does my hon. Friend agree with me—she is making this case anyway—about how unaccountable this body is? I have dealt with individuals who have fallen foul of it and I have written to it on their behalf, but it appears to take no notice at all of what an individual MP or constituent has to say.

[Liz McInnes]

I do agree, and I thank my hon. Friend for that intervention. I should add that while I worked for the NHS, I was a trade union rep for Unite the union and had many encounters with the HCPC. I found it to be opaque in its dealings and difficult to deal with.

I want to mention the effect of the fee increase on part-time workers, because scandalously there is no difference in fees between full-time and part-time workers, so it will have a disproportionate effect on part-time workers, who in the NHS are predominantly female.

If we look at what the HCPC actually does, we find, from its 2018 annual report, that it dealt with complaints against only 0.64% of registrants and that it sanctioned only 0.09%. Many members comment that they receive no benefit or professional services at all from their registration. As we have just discussed, the HCPC operates in a very opaque manner. Trade unions are not recognised within its own workforce, so there is no collective pay bargaining for its own employees, and so we do not even know what the HCPC pays its staff.

The HCPC says that it needs this increase so that it can deliver smarter regulation, improve services and mitigate the impact of the transfer of the regulation of social workers to Social Work England. However, I have already talked about how few fitness-to-practise cases the HCPC deals with as a proportion of the total membership. When social worker regulation moves to a new regulator later this year, that should lead to a reduction in fitness-to-practise expenditure, given that 59% of that expenditure currently goes on social work cases. The HCPC’s costs should decrease, not increase, which makes this demand on registrants even more unjustified.

This is Healthcare Science Week and I pay tribute to all the scientists working across our NHS. Their work quite often goes unrecognised, but is an essential component of the diagnosis and treatment of disease. Healthcare scientists and allied health professionals are a vital part of our NHS team.

In conclusion, I call on the HCPC to pause, to delay any decision to increase fees, and instead to explore alternative ways to reduce costs and to fully assess the impact of the transfer of social workers.

--- Later in debate ---

[Rachael Maskell]

Students do have responsibility, but the registered health professional is responsible for ensuring that they are safe under their practice while they are training in their profession. Training the future workforce is an incredibly important additional function of health professionals.

The Law Commission came forward with a set of recommendations for registrant bodies in 2012. In 2019, we still have not seen the implementation of those recommendations in full. I would like the Minister to explain why that is the case. Implementing a substantial piece of work about ensuring patient safety should surely be at the forefront of the Minister’s agenda. I am interested to hear the reasons for the delay, and what plans there are to put those recommendations in place. Training programmes for health professionals need to focus on the ethics, behaviour and conduct of health professionals, if we want to see a reduction in the number of cases. Managing that risk is really important.

I want to raise a number of points to move this case forward. First, as we have heard, 38,000 people signed a petition to register their discontent with the fee rise. That cannot be ignored. These are valuable NHS workers. Their call must be heard and reflected on. However, the HCPC hardly seems to have taken that into consideration. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, the number of fitness-to-practise cases being taken forward—currently, 59% of them involve social workers—will disappear. Therefore, surely the registrant body’s costs will decrease. We want to hear how that will benefit health professionals.

This is a tax on professionals. Will the Minister consider funding that regulation fee through the NHS? It does not make sense for nurses, physios and speech therapists, for example, to pay a different amount. That is a tax on professionals who have put in the training and the hours, and go over and above the hours. Why can the Government not pay the amount for each health professional? More than a gesture, it is a responsibility of the NHS to ensure that its registrants, including part-time workers, have that support. I completely concur with the suggestion made by my hon. Friend the Member for Heywood and Middleton that there should be a part-time rate.

[Dr Drew]

Forgive me if I am being simple, but do we know where the extra money is going and what the HCPC is doing with it? Can it explain that? Are the Government holding it accountable? Can my hon. Friend throw some light on that?

[Rachael Maskell]

My hon. Friend makes such a good point. I wish I could explain that, but to me it seems to be more money and less work. I am as baffled as he is about why health sector workers have to pay into this institution to do less work. I worked as a part-timer when I was head of health at Unite. Although I worked at weekends, I had to pay the full fee, so I certainly understand the frustration. Of course, that mainly affects women, who are more likely to work part time.

Finally, I ask that an expansion of the number of registered health professionals should be considered—after all, this is about keeping the public safe. We should know that the title under which the professional acts is secure and represents them. Certainly psychological services, such as psychotherapists, have requested to be registered, as have community nursery nurses. It is perplexing that the registration of nursing associates on a register—not this one—has been accelerated, but the registration of community nursery nurses, who have long asked for that, has not happened.

I would go further and say that, as we are looking at the future of the social care workforce across the country, we should also look at individuals who are singlehandedly going into people’s homes but who do not have the protection of being on a professional register. Ultimately, that is about keeping the public and our health professionals safe and secure. What steps is the Minister taking to ensure that a greater number of professionals are protected under the existing regulatory regimes?

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr McCabe. Like everyone else, I congratulate the hon. Member for Coventry South (Mr Cunningham) on securing this debate. He made an impassioned speech that aired his campaign, which he has led with style and impact. The Health and Care Professions Council is one of nine UK-wide regulators. It performs an important role in the health and care sectors across all four countries of the UK, acting in patients’ and service users’ interest to ensure the professional standards we need to guarantee safety and quality.

Right at the start of my speech, I pay tribute to all the dedicated professionals who work in the professions governed by the HCPC. It is also right to respond to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders). He said, if I heard him correctly, that it was irresponsible of the Government not to intervene. There is an important point of principle here: the HCPC is independent of the Government. It is funded by registrants’ fees on a cost-recovery basis. It is therefore not the Government’s role to tell the HCPC what its fees should be. It is not a question of hiding or a lack of political will; it is a matter of law. As the hon. Gentleman knows, there is a mechanism for oversight of the HCPC, which is the Professional Standards Authority. It oversees the HCPC and its setting of fees.

It has been an excellent debate with lots of useful and informed contributions. I have been in a number of debates with the hon. Member for Strangford (Jim Shannon), and he spoke with his usual passion not only on behalf of the people of Strangford, but in the wider context as well. I want to pick up on what the hon. Member for Heywood and Middleton (Liz McInnes) said; I was listening carefully to her contribution. She is right that the vast majority of registrants have very little contact with the regulator between renewals of their registration. That may be a frustration and not seen as value for money, but from the other point of view, the HCPC’s largest expenditure is on delivering the fitness-to-practise function. It is therefore inevitable that it concentrates on the very small number of registrants whose performance or conduct has fallen below the expected level.

The key thing is the need for regulatory reform, which the hon. Member for Ellesmere Port and Neston was challenging me on a moment ago. We have recognised that regulators have inherited a complex and restrictive registration practice that is often bureaucratic and administratively burdensome. As he rightly pointed out, the four UK Governments consulted on proposals for reforming the legislative structure of professional regulation. That consultation finished last year.

The reforms that we are looking to make, and are still committed to, will shift the balance in professional regulation, freeing up the regulators to concentrate more on prevention and to work directly with registrants, rather than just on fitness to practise. I assure the hon. Gentleman that it is not our intention to hide that. We intend to bring it forward, and we will do so in the near future.

I was listening carefully to the hon. Member for York Central (Rachael Maskell). She made a point about the need for registration and also for the system to be updated. The Government are committed to that. I also listened carefully to the hon. Member for Blaydon (Liz Twist). She spoke with knowledge and mentioned a number of the fitness-to-practise cases she has been involved with. She was right to point out that the vast majority of those have been social care cases over a number of years. That brings me to a key point. A number of Members raised the issue of the HCPC’s costs potentially going down as a result of social workers moving out of that regulatory process. I have not looked at that in great depth, but it is highly likely that variable costs will decline for the HCPC. As a number of Members have pointed out, social workers make up the vast majority of the professions that are regulated—more than 25%—so there is an element of fixed costs. They are being helped by the establishment of Social Care England, and the costs are being met by the Government.

The HCPC currently regulates 16 professions. The hon. Members for Coventry South and for Ellesmere Port and Neston read out the list of professions, so I will not rehearse them all over again, but I reiterate my point: these valued professionals are performing crucial roles across the NHS and the wider health and care system. It is important that the public have assurance that those professionals are regulated. If they are regulated by the HCPC, the public knows that they are appropriately trained and hold the relevant qualifications, and that they meet the expected standards of conduct, performance and ethics. Where a professional falls below these standards, it is important that the HCPC is able to protect the interests of patients.

I take the point made by a number of hon. Members that the HCPC currently has the lowest registration fees of any UK-wide regulator in the health and care professions. It is clearly not right to look at that in comparison with some of the more highly paid professions, but it is true that the current annual registration is lower than that for a number of others, such as nurses and midwives. I also take the point that the proposal is for a large, one-off increase, but there has not been an increase for two years, and the registration fees are tax-deductible, so the increase will amount to about £1 a month.

A number of Members mentioned the disparity between the fees that are payable by part-time and full-time staff. I have listened carefully to that argument, and I will write to the HCPC to ask it to look at that more carefully. That seems to me to be a fair point.

A number of Members raised points about the consultation. The legislation that founded the HCPC required it to consult on any fee increase. Accordingly, it ran a public consultation, to which it received 2,396 responses. Some 95% of those responses were from professionals whom it regulates. It also engaged extensively with professional bodies, trade unions and other bodies ahead of and during its consultation. The draft response to the fees consultation was published with the HCPC’s council papers of 14 February. It is right that 90% of the respondents did not support a proposed fee rise.

However, it is fair to note that the majority of respondents also wanted HCPC to invest more in prevention and improved services, in increasing capacity, and in improving the quality and timeliness of the fitness-to-practise services that it delivers. Everybody accepts that no fee rise is popular, but the HCPC has been clear that the principal reason for this one is to allow it to deliver the services identified by registrants in the consultation.

[Dr Drew]

The Minister will have heard my earlier intervention. Will he assure us that he will ask for complete transparency and accountability, so that we know what the additional costs will go towards?

[Stephen Hammond]

I listened to the hon. Gentleman, and I will make a promise to him. As I pointed out at the beginning of my speech, it is not the Government’s role to tell the regulator how to set its fees or what to set them for. However, I see no reason why the Professional Standards Authority should not ask the HCPC to give that reassurance and to publish that information. I will write to the hon. Gentleman when I have spoken to the PSA to ensure that it can do that within its remit. Given that it has oversight, I am sure that that will be possible.

Exiting the European Union (Medicines)

David Drew Excerpts

Tuesday 19th February 2019 Commons Chamber

[Dr David Drew (Stroud) (Lab/Co-op)]

Let me start by thanking the Department for an actual impact assessment. I have attended too many debates on statutory instruments when there has been no impact assessment. At least we know what we are talking about on this occasion, and I congratulate the Department on that.

I shall make three very brief points to which I hope the Minister will be able to respond. First, the headquarters of two of the top 10 pharma companies, GlaxoSmithKline and AstraZeneca, are in the United Kingdom. That matters, because there is considerable evidence that the location of the headquarters is the location of much of the investment in clinical trials. We need to maintain that hegemony, and ensure that we keep those trials here. How do the Government intend to guarantee investment in both the industry and the clinical trials?

Secondly, the industry is very concentrated. I know more about animal medicines, because of my involvement with the shadow DEFRA team. For instance, it was decided that the trial of the bovine tuberculosis vaccines for badgers had to end because the vaccines were needed for human use. There was one major company in Paris. That shows what the industry is really like, and that is why I fear that if we do not get this right, it will drift to other parts of the EU and we will lose out.

My third point is about barriers. This is not just about physical resources, the drugs and chemicals themselves; it is about people. We might find ourselves in a very difficult position, particularly if we were to crash out, heaven forbid. How does the Minister intend to ensure that, in such an event, the key people will be able to secure transferability between the UK and the rest of the EU? That issue is heightened by the enormous pressure on the MHRA in connection with a crash-out. It would be useful to know from the Minister what we will do on the people side to ensure that we genuinely defend the industry.

There is important health investment in pharma companies in my constituency, as there is in many other constituencies. It really does matter to us all to know that there is some certainty in what is a very uncertain process.

NHS 10-Year Plan

David Drew Excerpts

Tuesday 19th February 2019 Commons Chamber

[Dr David Drew (Stroud) (Lab/Co-op)]

I shall be very brief and make one point.

I am pleased that this Government have seen the light. Whereas previous Governments made mistakes in going for large-scale reorganisations, this Government seem to have learned from them and I am very pleased about that. The problem is that trusts now seem to have turned their attention to community hospitals. I have two excellent community hospitals in Stroud and the Vale, but we are now facing the loss of radiography time. Minor injury units are not facing closure but they have restricted opening hours, and operating theatres are frequently left empty. That simply results in more pressure on acute hospitals, so it is counterproductive.

Will the Minister look at the impact on community hospitals, which are really important to rural areas? It is vital that we see them play an integral part in our NHS. Otherwise, we will just have A&Es snarling up and that is not acceptable in any way, so I hope the Government will invest time and effort and encourage trusts to reconsider the value of community hospitals.

Appropriate ME Treatment

David Drew Excerpts

Thursday 24th January 2019 Commons Chamber

[Dr David Drew (Stroud) (Lab/Co-op)]

I shall be brief, Madam Deputy Speaker.

I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing this debate through the Backbench Business Committee. I shall try not to go over ground already covered, but I must pay due regard to my constituent Dr Charles Shepherd, who continues to advise the ME Association and has come forward with many suggestions that it has followed.

On medical education, there is evidence of some progress, which is very pleasing. GPs are the gatekeepers and need to recognise ME at an early stage so they can help their patients. It is heartrending to read what constituents have written to me, particularly the parents of younger children suffering dramatically from this dreadful condition. The PACE trial and the need for a rewrite of the NICE guidelines have been touched on already. It is important that NICE bring that forward. It would be interesting to know why the Government have cut the money for biomedical research and the National Institutes of Health. If that money could be put back in, that would be one bit of good news the Minister could give us. My hon. Friend the Member for West Bromwich West (Mr Bailey) touched on the role of the Department for Work and Pensions. It is important that this condition be recognised and that sufferers get early support. On the work of clinical commissioning groups, the NHS has to do more and spend its own local resources.

To finish, I want to touch on the overlap with B12 deficiency, which has not been mentioned yet. Autoimmune metaplastic atrophic gastritis, previously known as pernicious anaemia, is often confused with ME. It is very important that we encourage local health bodies to rewrite the rules for that condition as well to ensure that people are correctly diagnosed. It is very unhelpful when people’s conditions are not properly recognised as it can result in a downward spiral of psychological problems. It is about time we spent the necessary resources on this condition and gave the necessary help to sufferers.

Mental Health First Aid in the Workplace

David Drew Excerpts

Thursday 17th January 2019 Commons Chamber

[Luciana Berger]

I thank my hon. Friend for her important intervention. Of course, today we are talking about what happens in the workplace, but what happens with young people in places of education is equally critical. I sit on the Health and Social Care Committee, and we have interrogated the Government’s plans for the next generation and young people. There are plans in place to have a designated mental health senior lead in every school, and we should ensure that at least one person has that training. We could be doing better than that, but at least it is a start. I support the idea, and it is great to hear what is happening in my hon. Friend’s constituency.

Let me be very clear that we are talking about a huge number of people affected in our country every single day—our friends, colleagues and workmates who surround us. There is, of course, a huge economic cost as well as a very significant human cost. The Centre for Mental Health estimates that people with mental health conditions staying at work longer than they should costs our economy over £15 billion every single year, and that people being absent from work because of mental ill health costs our economy £8 billion a year. These are not insignificant sums. I reiterate that 300,000 people with a long-term mental health condition are losing their jobs every single year because they find themselves in an acute state, have to leave work, are not supported and get to a critical state, rather than having experienced early intervention or prevention, which might have helped them in the first place.

The Health and Safety Executive says that 15.4 million working days were lost in the last year alone because of stress, depression and anxiety, and the British Association for Counselling and Psychotherapy—I declare an interest, as I was recently appointed one of its vice-presidents— has calculated that stress is costing British businesses £1,000 per employee per year in sick pay and associated costs. That is very significant for the national economy, and for individual organisations and businesses. I do not think I need to set out any more statistics to evidence the fact that there is a clear need. Mental illness is having a significant impact on millions of workers across the country and costing our economy billions of pounds.

[Dr David Drew (Stroud) (Lab/Co-op)]

My hon. Friend is making an excellent speech. As we have all heard in our constituency surgeries, one of the real costs is that people who suffer from mental illness find it very difficult to get back into employment because of the stigma, and I have to say that the public sector is among the worst at having a bias against people with mental health problems. Does she accept that?

[Luciana Berger]

I thank my hon. Friend for making that important point. I am going to move on to talk about tackling the stigma and discrimination that we know still exist in our country. We have made some progress in the national conversation about tackling mental ill health, particularly with the younger generations, but in too many workplaces and too many communities, there is still the discrimination and taboo connected with mental ill health. As a constituency MP, I see that almost weekly. Men of an older generation feel that they are able to talk to me because I campaign on this issue and am very open about it, but they are perhaps unable to speak to their work colleagues—sometimes not even to their close family—because of the discrimination that they feel still exists. We are certainly on a journey as a country.

One objection to this proposal might be that mental health requires highly specialist medical intervention, not someone in the workplace with only a few days’ training—and of course that is absolutely true. Mental health conditions do require specialist diagnosis and treatment. That is why many of us, on both sides of the House, have been calling for more investment in this area to ensure that we have the clinicians within our NHS to address the mental health crisis in this country. But let us be very clear that this motion, with this specific initiative, is not seeking to substitute mental professionals with mental health first aiders. Mental health first aid training gives people the knowledge, the skills and the confidence to intervene early if someone is struggling with their mental health. It is not in any way intended to be a replacement for trained mental health professionals, either in the NHS or in our workplaces; rather it offers an early warning system and an opportunity for employee support. It is also, in response to the point made by my hon. Friend the Member for Stroud (Dr Drew), aimed at tackling the taboo that we often see. Raising awareness of mental ill health and placing it on an equal footing with physical ill health tackles some of the stigma and discrimination that we still have to break down.

If any colleagues would like a clearer explanation, let me say this. All of us here present would know where to go for assistance if we had a physical injury. If we had perhaps slipped, or had a burn or a cut, we could go to the officers just down there through the Chamber. Perhaps, either in this place or in a previous role, we were that first aider. But how many colleagues, or their staff would know where to go if they were struggling with their mental health? How many would have known who that person was, or if they existed at all, in their previous job? Training people in our workplaces in mental health first aid would mean that employees in workplaces right across our country had an instant answer to that question.

No one should assume that a mental health first aider is the same as a mental health professional, any more than anyone assumes that a current workplace first aider is the same as a heart surgeon, an A&E doctor or a cancer specialist. The point is that a mental health first aider provides early intervention and a critical and important signpost. They would be able to answer questions about how and where to go to get treatment. They can help to change the culture in an office or on a shop floor so that someone with a mental illness has support. They can provoke a conversation about mental health that can break down some of the stigma and prejudice. They can be a valuable first point of contact for someone struggling with their mental health in what might otherwise feel like a very lonely environment.

We do not need to talk in purely hypothetical terms. At the end of last year, the Where’s Your Head At? campaign sent a letter to the Prime Minister in support of statutory mental health first aiders. It was supported by over 40 businesses, including WHSmith, Standard Chartered and Thames Water. I am particularly proud to say that a friend of mine and good Labour colleague, Sadiq Khan, the Mayor of London, has, in the capital, done so much on mental health first aid training at City Hall and in London’s schools as part of his public health strategy. St John’s Ambulance will have trained 10,000 people by the end of this last period. Mental Health First Aid England has now trained over 350,000 people in mental health first aid. Councils are investing in this and other providers are making similar strides forward. Those who have completed the training say it is hugely beneficial to them and their co-workers. It gives people the skills, knowledge, confidence and language to spot the signs of mental ill health, provide support and make early interventions. But most critically, it is helping the people affected. It really can make a difference.

One of the elements of the mental health first aid training that I completed was about what to do if someone you work with is experiencing suicidal ideation and might be considering taking their own life. Some 6,000 people in our country have taken their own life in the past year and this particularly impacts on young men. This is an area where quite often people do not know what to say or do, but training such as this, and training from the Zero Suicide Alliance, which offers a free online half-an-hour session, are the tools that can really make a difference. In some cases, it really is a life or death situation.

A number of unions have come out in support of the change to the law we are seeking to make today. Community, The Teacher’s Union and Unite were all signatories to the letter to the Prime Minister I just mentioned, and the Communications Workers Union and the GMB have since joined calls for this change to the law.

The costs of training—another question that is often raised—are very clearly outweighed by the benefits of better mental health in our workplaces. Training can typically take place over a number of days, but it can also take place over one day—or half a day, providing opportunities particularly for small businesses and organisations to train people in mental health first aid, too. The training that I did was with the Liverpool city region Mayor, Steve Rotheram, and the senior leadership of Merseytravel in Liverpool. I have half a day left to do, but I have done almost the whole course and seen what the benefits can be. So we do not need to gaze into a crystal ball. We can talk to people who have been trained. But again, in particular, we can reflect and engage with the people who have been helped.

I would like to share some of the thoughts of organisations that have gotten in touch in recent days to share their experience of training mental health first aiders, the value they place on this important initiative and why they are supporting our call today. The insurance company AXA has trained over 100 of its staff to become mental health first aiders, so now each of its UK offices has one. It has also trained as mental health first aiders the staff of the companies that it provides insurance to, helping other businesses across the country to improve mental health in their organisations.

Another success story is that of Thames Water, where 350 employees across the organisation are trained in mental health first aid. They wear green lanyards so that they can be easily identified by the wider workforce. A further 250 employees have joined the company’s mental health online engagement forum. Thames Water has calculated that there has been a 75% reduction in work-related stress, anxiety and depression among its employees—a not insignificant impact.

Colleagues may not know—I was certainly not aware of this—that the construction industry is the sector where workers are most affected by mental ill health. In response to that, the Construction Industry Training Board has now committed £500,000 to the Building Mental Health initiative, which will train 156 construction workers as mental health first aiders. Further to this, Mates in Mind is a fantastic charity that works to address the stigma around poor mental health and improve positive mental wellbeing in the UK construction industry. It aims to have reached 75% of the construction industry by 2025.

I give these examples as evidence to colleagues that a number of businesses across the country have been proactive in their approach to mental health and are reaping the rewards. There are many more I could have shared, but I am conscious that many Members want to contribute to the debate.

This is an idea whose time has come. In a decade from now, when mental health first aiders are an established part of the workplace, we will wonder why we did not start sooner. It is good to have the Minister here today. As I am sure she recognises, this is a measure that can bring us together across party lines. The Minister and the Government have the chance to do a really important thing in supporting this motion. I should say that that is in line with their own pledges in the Conservative party manifesto in 2017. The Government have the opportunity to amend the 1974 Act and to take a clear step towards achieving real equality.

The term, “parity of esteem”, may seem meaningless, but it means real equality between physical and mental health. We legislated for that principle in the Health and Social Care Act 2012. We are now seven years down the road and still waiting to realise that ambition. The Minister will also know that the Prime Minister has been clear on this from the start of her premiership, when she made the commitment to address the inequality between physical and mental health one of the key “burning injustices” that she wanted to erase. This motion, and the policy that it seeks to implement, gives the Prime Minister and her Government the opportunity to solidify her commitment to this mission.

Unlike certain other matters that we are discussing in the House this week and over the weeks ahead, this initiative has cross-party support. It has the support of businesses and of our constituents—over 200,000 people have signed the petition. It has the support of so many mental health campaigners across the country. I sincerely hope that all Members on both sides of the House will support it here this afternoon.