Nursing: Higher Education Investment

David Drew Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

Absolutely. That is where nursing is important. Nurses are becoming specialists in Parkinson’s, Turner syndrome and sickle cell, all of which are specialisms that will be required in the future of nursing.

Nurses are working in cutting-edge research on ethics, safety, improvements to care and new ways of working. They are leading from the frontline, and as professionals they should be at the heart of strategic policy making. Nursing is at a critical junction in our healthcare and systems, yet the Government are without an independent chief nursing officer after the removal of that critical leadership post from the heart of the Department of Health and Social Care. That is an insult to the nursing profession.

How many of my right hon. and hon. Friends are regularly contacted by their constituents about health and social care issues—people struggling, writing about services being reduced or cut, unable to access support without help? Increasingly, that is happening because there are not enough staff to run things safely. Across the country, nurses are clear that staffing for safe and effective care is their most important priority and their biggest worry.

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

Does my hon. Friend accept that in the specialisms in particular—in my own area, the problem is with learning disabilities—there are such reduced numbers going through training because of the loss of the bursary, that it will have a huge impact on care homes and other forms of care delivery? Does she see that as a total tragedy?

[Eleanor Smith]

I do, and I will talk about that in my speech and touch on the lack of nursing students coming into those particular areas because of the bursary’s disappearance.

Hospice Funding and the NHS Pay Award

David Drew Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes]

The right hon. Gentleman is absolutely right. I will explore the Agenda for Change later, because adopting it presents huge difficulties for non-NHS organisations.

The three points from the chief executive of Springhill Hospice were tabled as parliamentary questions. Sadly they received identical answers that included:

“We are considering carefully the impact of any agreement on non-NHS organisations such as hospices that may be affected by the proposed pay deal; however no decisions have been made. Staff in hospices do a fantastic job in delivering world-class care and the Department remains fully committed to improving palliative and end of life care.”

In July, I wrote to the Secretary of State for Health and Social Care, asking for an update on the issue. The response stated that he “understood concerns” that

“hospices may find recruitment and retention challenging if some of their staff choose to leave in favour of organisations that employ staff on the Agenda for Change contract”.

In summary, the Government will finance the pay award for non-statutory, non-NHS organisations only for organisations employing staff on the Agenda for Change contract, which is the nationally agreed set of terms and conditions for most NHS staff. The rationale for that was that:

“Additional funding relies on organisations employing staff on the Agenda for Change contract, because it is the Agenda for Change pay and non-pay reforms that together will help deliver the productivity improvements the Chancellor asked for in return for additional pay investment”.

What are the reforms that can only be made under Agenda for Change? On examination, it seems to be an emphasis on training and apprenticeships and a programme of appraisal and personal development. There is also a slightly vague statement on the improvement of the health and wellbeing of NHS staff, to improve levels of attendance, with a reference to

“positive management of sickness absence”,

whatever that may mean.

The response from Springhill Hospice was grim. The chief executive wrote to me:

“Very few charitable hospices employ their staff on Agenda for Change contracts, and as a result, Springhill Hospice, along with many other hospices, will miss out on the funding being set aside by the Government. This will place us at a considerable disadvantage in recruiting and retaining essential staff to deliver the services that we offer to people with life-limiting illness in this community, and will leave us with a significant additional cost.

Recruiting and retaining skilled staff is a critical challenge for us, and in order to remain competitive, we will have little choice but to increase pay for clinical staff. Over the course of the three-year NHS pay deal, we estimate that this will bring an additional cost to the hospice of in excess of £250,000. Without support from the Government, this extra cost can only be met by asking our communities to give more, or by reducing the services that we provide.

We are already asking our community for in excess of £2 million contribution each and every year, and in an area of high deprivation, I can only envisage that any additional ‘ask’ will not be able to be met by our community, so sadly we may have to look at service reduction, which in turn will place additional burden on an already stretched NHS.

NHS staff will start to see the pay increase reflected in their pay packets from this month onwards. Without government support, Springhill Hospice will see a significant additional cost fall to the charity as a consequence.”

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

My hon. Friend is being very generous with her time. Does she agree that one problem, shared by Longfield Hospice in my constituency, is the opaqueness about the money that the NHS puts into the hospice movement? It does not put much in, and it is unclear why it comes and what it should be used for.

[Liz McInnes]

I certainly agree with my hon. Friend. While preparing for the debate, I tried and failed to get clarity on how NHS funding is allocated to hospice services. I hope that the Minister will provide some clarity on that.

The chief executive of Springhill said that the Department’s response was unhelpful, and that if the hospice were to utilise Agenda for Change terms and conditions in full, it would have to go through a massive consultation with staff and would need to change everyone’s terms and conditions of employment, assuming that there was buy-in through the consultation process. In addition, it would have to employ a very bureaucratic appraisal system—it already has robust appraisal processes in place—while adopting the Agenda for Change process would necessitate a massive investment in staff training, which would again add to the cost burden.

ME: Treatment and Research

David Drew Excerpts

Thursday 21st June 2018 Westminster Hall

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

I am delighted to take part in this important debate. I thank the hon. Member for Glasgow North West (Carol Monaghan) for introducing it and all other hon. Members who supported the application for a three-hour debate; we will certainly need it with the number of hon. Members who wish to speak.

I owe my knowledge of ME to friends who have suffered from it and, particularly, to constituents who have written poignant letters to me about their experiences and the hurt they have suffered when people just would not recognise that they had a condition—whether we call it ME, chronic fatigue syndrome or a post-viral condition. All those different elements make ME a problematic condition.

I mainly want to thank my constituent and friend, Dr Charles Shepherd, who is in the Gallery and to whom I mainly owe the few words I will say. He has advised the ME Association for many years now. Along with Dr Chaudhuri, he has written a book on ME. Hon. Members might like to go through it if they have a few moments; I went through it again last night. They will be staggered by some of the things that they did not know. However, I have to say that it is not the easiest read. It is very technical and very medical, but this is an incredibly technical and medical disease, which is why we do not know enough about it.

I will try to avoid the points made by other Members, but I make no apologies for going through some of the points made to me by Dr Shepherd. I also mention Sarah Reed—the wife of Andy Reed, the former Member for Loughborough—who has for a long period of time also suffered from ME and has been in touch with me about it on many occasions.

On medical education, it is quite clear that GPs, in particular, have no experience in how to diagnose this disease, so there is a need for training at both undergraduate and postgraduate level to make sure that doctors become more aware of what the condition looks like and the ways in which they could begin to treat it. That continuing lack of medical education adds to the misery that our constituents have faced. Dare I say it, it behoves the Minister—I know he will be tied in what he can say—to say something about the training programmes that we should expect our doctors to go through. It is vital that ME is understood not only by junior doctors but all the way up through the profession. We have understood, from some of the arguments on research, that there are still those who are not necessarily as keenly aware of ME.

[Michelle Donelan]

Does the hon. Gentleman agree that this is about awareness not only among doctors but among teachers, employers and the wider community? The lack of knowledge in those sectors exacerbates the conditions that those with ME suffer from, and that causes great distress.

[Dr Drew]

I agree, and the hon. Lady makes her point strongly. All I will say is that I will concentrate mainly on the medical side of things. However, everybody needs to be more aware because of the numbers—two in every 1,000 people are thought to suffer from the condition.

We have heard a lot about the PACE trial and the need for NICE to rewrite its guidelines, so I do not really want to labour those points, other than to say that it is not helpful that cognitive behavioural therapy and graded exercise therapy are still suggested as the appropriate way forward after ME diagnosis. We know for all sorts of reasons that that is not so. I am sure the Minister heard that and will want to comment on it.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My constituent was diagnosed with ME but, after going for a private test, it turned out to be Lyme disease. That shows the lack of knowledge and the confusion in the medical profession between those two conditions and others.

[Dr Drew]

If my hon. Friend reads Dr Shepherd’s book, he will see some of the overlap between Lyme disease and ME, as the hon. Member for Glasgow North West mentioned. That is why this whole area needs proper diagnosis and a proper investigation into some of the research implications.

On research, as has been made patently clear by other Members, most of the research is self-help. That is not good enough. This is a major condition that affects lots of our constituents, and yet they are asked to raise all the money for research themselves. That is not good enough, so we clearly ask the Government—as the Minister will have heard—and the research councils to give ME the priority that it deserves.

[Sir Henry Bellingham]

I hope the hon. Gentleman will support my campaign to get the Government to invest in the Invest in ME Research centre of excellence in Norwich. I did not mention that it has a really good chance of forging first-class links with not only European biomedical research institutes but institutes in the United States and Asia, where other groundbreaking research is being done. The Government should support and invest in success.

[Dr Drew]

I think that was aimed more at the Minister than me, but I totally agree with the hon. Gentleman. I gather that the National Institutes of Health in America has begun to grapple with this and to put some quite serious funding into it. ME is an international condition, so we should hope that the Medical Research Council is also able to provide that level of support.

We have heard about the impact of ME on people who go for benefits interviews with the Department for Work and Pensions. As the hon. Member for Glasgow North West mentioned, it is difficult to get those who judge people’s conditions to understand how variable ME is. When people are going for employment and support allowance, personal independence payment or, as has been the case more recently, universal credit, account needs to be taken, when practitioners are making decisions, of the fact that the condition is variable. Sadly, all the evidence is that that is not fully understood. Again, this matter is not the Minister’s responsibility, because it overlaps with the remit of the DWP, but I hope that he can take away from what has been said here today the fact that the DWP needs to be much more aware of what the condition entails, rather than making judgments on what they see the person performing in front of them.

I think that the most important point of all is that we all could put pressure on our local clinical commissioning groups to show greater recognition of how important it is that they fund ME, in terms of both support for the individual patient and looking at how they commission the moneys that go into the services. Clearly, this remains a Cinderella subject, but given the numbers affected and the misery suffered by people with the condition, that is not in any way acceptable, so I hope that as a result of today—again, the Minister will hear this—we might all be able to go out and talk to our CCGs about what evidence they can provide us with to show that they are properly funding treatment of this condition. As we all know, what has happened in the past has been totally unacceptable. Let us hope that there is a better world now and that we can all play our part in ensuring that this condition is treated with the seriousness that it deserves.

Privatisation of NHS Services

David Drew Excerpts

Monday 23rd April 2018 Westminster Hall

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

It is a delight to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for introducing the debate. It is an interesting opportunity to make some comments, perhaps sandwiched between two other Gloucestershire MPs. I will not say that is a delight, but there is much wisdom in what the hon. Member for Gloucester (Richard Graham) says.

Sadly, I have always believed that the NHS has been a party political issue from its very start. However, there is some ground for consensus on properly funding the NHS. There may be some disagreements about how we achieve that, but we have to lay down the ground by which we might know what we should fund, which of course includes the care service.

I intend to make a brief speech that is really only about subsidiary companies, because that is particularly apposite to us in Gloucestershire. However, I make one rejoinder: we actually defeated the PFI deal in Gloucestershire. We were offered one, but I thought it was very bad value for money, and I was one of those who spoke out against it. I think we did the right thing. We now have two fit-for-purpose hospitals, even though to get to this stage we have had to go down a pretty rocky road.

I will devote my comments to the setting up of a subsidiary company in Gloucestershire, about which the hon. Member for Gloucester made an aside. It was something I opposed, because I felt that it was the wrong direction to go in. More than anything, I felt very strongly that it was not properly scrutinised. It is the only time I know of when there has been a major change in the structure of our hospital provision in Gloucestershire, including to staffing, and the public and their representatives—including the health and care overview and scrutiny committee, which was effectively told to take its nose out of its interest in the change—have been excluded from the consultation.

The big change is that up to 700 members of staff will be taken out; there is an argument about exactly how many. I have met the chair and the chief executive of the trust, and I know why they have done it. It is about money and about trying to make good the real funding shortfall that has affected us in Gloucestershire because of the deficit that we have built up over quite a long period of time, and which we at least have to be seen to be talking about.

I will concentrate on a number of issues. I hope the Minister listens, because I will ask him several questions specifically about where we will go as a result of the changes. I resent the fact that representatives from Gateshead Health NHS Foundation Trust are going around the country as snake oil salespeople and telling trusts how they can save money. I and other Members have asked parliamentary questions on this subject, and my first question to the Minister is this. Can we have it on the record that the setting up of subsidiary companies will not be financed by some sort of VAT exemption? That is where the proposal initially came from. Although I have had assurances from the NHS, the Health team and the Treasury, the message does not seem to have gone back to those who still propose the idea. Can we have it on the record that there will be no VAT opportunities because of these new so-called subsidiary companies, in Gloucestershire and elsewhere in the country?

The second point I will look at is where the benefit of this change will be. I would have liked to see the full business case, but we were precluded from seeing it. We saw, dare I say it, a fairly anodyne version that looked as though it was all things to all people, but that did not really say how the change would be better—initially for the staff but also for the people of Gloucestershire—given that a large number of staff who worked for the hospitals trust are now in a different company.

Does the change preclude tendering? One of the advantages sold to the staff was that they would not have to face any tendering, because they would join a subsidiary company that was part of the NHS but that was necessarily different from the NHS because of the changed terms and conditions. My second question to the Minister is: is that fair, or could this company at some future date be passed over—I will not say sold on —to A.N. Other, who could be either a not-for-profit third party or, dare I say it, in the private sector? That would suggest that this change is not much of a defence against tendering.

The third issue I raise is that our hospitals trust—I say our, because there are three Gloucestershire Members here—finds it difficult to recruit, and faces a lack of money. There is also an element of desperation, rather than innovation. My third question to the Minister is: if, as I am led to believe, there will be a major pay increase for ancillary staff of as much as perhaps 15% over the next year, how can that be squared with other changes that will come further down the line?

My worry is that we—the proverbial we—have sold people an idea that they can get more money now and it will not affect their future prospects, yet we know from what has been suggested that it will have an impact on pensions. I know we do not have an NHS pension scheme any more; there is a series of NHS pension schemes, some of which are much more generous than others. However, it seems that those who are now in a subsidiary company must end up with a worse scheme, because how can they have a 15% pay increase and the same pension provision as those in existing pension schemes? It is the same for job protection and some other elements of the way in which the NHS looks after its workforce. I know the Minister is a fair person—we have discussed things privately—but I genuinely do not understand how this will all add up.

I worry that we are offering people something in the short run that may be beneficial and may get them out of working in supermarkets and into working in the NHS—that is a good thing—but, worryingly, they may come out of working in the care sector to work in the NHS, and that will not solve our problem. Our problem is that there are a lot of staff who are underpaid and very mobile, and we need those people to be brought into the NHS, to stay with the NHS and to be secure in the NHS.

My last point is one that I am, if you like, quizzical about. Gloucestershire’s sustainability and transformation plan, which has now been published, was seen as the overarching way in which our NHS would develop. However, all these changes, including the merging of two trusts—a mental health and learning disability trust and a community trust—and the setting up of the subsidiary company, happened in advance of the implementation of the STP. What is the point of the STP if many of the changes have already been made? It would help me when I am talking to my constituents, who feel quite worried about what is going on, to know what these things genuinely mean and what they will result in. At the moment there are a lot of questions but very few answers.

I do not want to see fragmentation. We can make the argument about privatisation, but fragmentation weakens the bond that the NHS is about. It is the national health service, delivered free at the point of use to constituents in the various parts of the country, including Gloucestershire. At the moment, however, we seem to be seeing further fragmentation, which may lead to all sorts of risks.

The answers to my questions have not come forward. That may be because we did not have a consultation; that was wrong. We should have had a full-blown consultation so that these questions could have been asked, not just in Gloucestershire but elsewhere in the country in the places that have been mentioned. It is our duty as parliamentarians to make sure that we ask those questions and to try to get the answers.

The Minister has heard what I have said. I could go on about other aspects of the healthcare system in Gloucestershire, but the subsidiary company is of primary concern at the moment. We have one in Gloucestershire. We do not know who will run it, how it will be run or what the future implications are. If the Minister hears what I am saying and can answer some of those questions, it would help us in Gloucestershire and people much further afield.

GP Recruitment and Retention

David Drew Excerpts

Wednesday 28th March 2018 Westminster Hall

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

I am delighted to serve under your chairmanship, Mrs Moon. I congratulate my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) on leading the debate. I will be short, because I wish to make three key points and I do not need long to do that.

First, we have a recruitment and retention problem in Stroud, like in many other parts of the country. That became apparent to me only when I was re-elected, when I talked to various of my GP friends who were keen to retire and were not necessarily finding replacements easily. It is clear that at the moment there are huge gaps in the service. However, it is not necessarily that they are not being filled, because as my hon. Friend said, locum work is very popular. That is the main point I want to make. Because locum work is so popular, we have to look at the reasons why the traditional model is not working. Even for people who become doctors, it is not necessarily a lifelong career, so for all sorts of reasons buying into a practice now is not an attractive proposition. I ask the Minister to look at what ideas are coming forward, as it is clear that the traditional practice model, where a GP buys into the assets of the practice as well as becoming a doctor there, is now of a bygone age. That particularly matters because trying to get a lead practitioner is onerous, because they are often the only full-time doctor in their practice, which puts additional responsibilities on them. I hope that we can have some flexibility in how we attract people in, otherwise there is only one direction things will go.

Secondly, the number of people who start on the route to becoming a GP but do not end up as a GP in practice is disappointing. There is something wrong both in doctoring in general, and particularly in general practice, with the number of people who fall by the wayside. Again, as I have intimated, that is because there are attractive alternative career structures. There are ways in which people can be a GP part-time as well as doing other things, which may be commendable for someone’s work-life balance but does not fill the gap. I hope the Minister will look at what is happening to recruitment patterns. We need to recognise that eight or nine years is a huge investment, so if someone does not become a GP in some form or other at the end of it, it is a wasted investment. I hope the Minister will be able to say something about how we can ensure that people follow through on their training potential.

Thirdly, as my hon. Friend the Member for Houghton and Sunderland South mentioned, we need to recruit a number of doctors from overseas at least in the short run. Having talked to consultants and the Royal College of General Practitioners, I know that there is a problem at the moment—at least in perception, if not in reality—of people not wanting to doctor in this country when they would traditionally have wanted to do so. We need to overcome that problem urgently, because we need those people in place, otherwise, there will be an even greater shortfall.

My last point—it is not to do with GPs, but I think it is crucial—is about the pressure on other people within primary practice. I get calls continually from health visitors, practice nurses and physiotherapists saying how difficult things are, and that must have an impact on general practice. If we could ease some of the pressure on those people, we could only help those who want to be in general practice and be at the front end of our NHS.

Male Suicide

David Drew Excerpts

Wednesday 13th December 2017 Westminster Hall

[Ged Killen]

The hon. Gentleman is absolutely right. A lot of good work is going on around the country to encourage men to talk more.

Initiatives by the Samaritans and Time to Change encourage us all to think differently about mental health and suicide and to be alert when the behaviour of our friends, families and colleagues changes. Personal interventions can save lives and it is incumbent on us as individuals and as representatives to challenge traditional conceptions of masculinity, in particular when they pose a risk to life.

Put simply, men need to get better at talking to each other. I include myself in that. I have not always been good about talking about my own mental health and my experience of anxiety and OCD, obsessive compulsive disorder. We need to get over any embarrassment or awkwardness we might feel, and realise that sitting down for a simple cup of tea or coffee and asking a friend how he feels might be the thing that saves his life.

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

My hon. Friend is making a very powerful speech. Does he agree that we need to start very young with that? There is a lot of evidence to suggest that if people can talk about that when they are at school, that may be the greatest preventer of all.

[Ged Killen]

My hon. Friend is absolutely right, though early intervention with mental health is an entirely separate debate, which I suggest would want its own time. I certainly agree with his point.

As I was saying, if a friend is experiencing a suicidal train of thought, a simple chat might be just the thing to break that cycle of thought. It might refer the person to the help they need.

Suicide among men, however, can no longer be seen purely as a health issue. There is a statistically significant relationship between high levels of deprivation and high levels of suicide. That association means that as area-level deprivation increases, the likelihood of suicidal behaviour will probably increase as well.

Maternity Safety Strategy

David Drew Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I am intrigued to hear that, because my three children were born at the Chelsea and Westminster, and my wife would have been delighted if I had done a “dads to be” course. I will certainly look into that course and, I am sure, actively promote it.

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

May I concur with my hon. Friend the Member for Rochdale (Tony Lloyd) and say that, although safety must be paramount, it would be wrong to see this as a reason to shut midwife-led units and, in particular, discourage home births for women likely to have a safe birth who chose to have the baby at home? Will the Secretary of State say something to make sure that those units are safe?

[Mr Hunt]

I am very happy to do that. Midwife-led units and home birthing are both part of the NHS maternity offer, but it is wrong to suggest that there is a conflict between patient safety and the choice made by mothers. No mother would ever actively make a choice to do something that was not the safest option for her and her child.

World Antibiotics Awareness Week

David Drew Excerpts

Thursday 16th November 2017 Westminster Hall

[Julian Sturdy]

I know the Scottish Members would certainly agree with that. As Fleming said,

“it’s not very scientific—but it helps.”

We now need to make the message as clear as day: antibiotics are ineffective when taken unnecessarily and doing so bolsters resistance and endangers mankind.

The second area where significant progress can be made is on the incentives for antibiotic discovery, research and development. It should be noted that the antimicrobial challenge is as much economic as it is medical. We must find an alternative to the reimbursement model, whereby profitability of bringing new antibiotics to the marketplace is linked to volume of sales. That is because we are actually seeking to limit the use of such drugs to preserve their power; to use new drugs as a point of last resort, as it were. To use an analogy, it is almost like the fire service—we need it to be there and to be effective, but we do not want to use it. However, nobody would dispute the necessity of investment and funding for that key emergency service.

To overcome this task, it is essential that measures are taken to co-ordinate a review of progress in new drugs, alongside the activation of research and development by industry for new antibiotics and related products achieved by Innovative Medicines Initiative projects. On the economics, we need to seek innovative solutions, with the pricing conditions and “pull” measures needed for the long-term sustainability of new antibiotic development, so that they are promoted. An example of that is the compact initiative of the European Federation of Pharmaceutical Industries and Associations to promote a sustainable business model and adequate conditions for the introduction of effective new antibiotics.

The O’Neill review, published last year and described last week by a columnist from The Times as

“the best argued and most accessible”

report in his lifetime, was very clear on this matter. Lord O’Neill found that much more needed to be done to close the substantial gap in research and development funding between AMR and the best-funded areas of medical science. The report being launched this week quantifies this further, and states that $40 billion is needed over 10 years, representing about 0.05% of G20 countries’ current healthcare spend. I will not claim that that sum is insignificant, but it is certainly affordable given the magnitude of the threats we face.

For improvement on a global level, the report makes it clear that co-ordinated efforts must be made in the veterinary sector, where I am pleased that tangible progress has been made in the UK. Figures from the Countryside Alliance show that sales of livestock antibiotics across the sector have fallen by an average of 27%—their lowest levels since records began—which is a good start, because a failure to address AMR in livestock has fundamental implications for the treatment of human diseases. For that reason, mirrored co-operation between Government Departments is essential.

While I am delighted that we are joined by my hon. Friend the Under-Secretary of State for Health, this matter also encompasses the Department for Environment, Food and Rural Affairs, the Department for International Development and the Department for Exiting the European Union. We need a clear commitment from the Government that that co-operation is there and that an interdepartmental strategy is on the agenda. Beyond that, we require what Antibiotic Research UK describes as a “grand alliance” to come together, comprising the Government, the pharmaceutical industry, collective medical research charities and academics.

To reduce further the overall use of antibiotics in the veterinary sector, guidelines have been developed for prudent use. The EU road map also proposed the creation of an animal health legal framework, based on the principle that prevention is better than the cure. Take the example of colistin. In 2015, evidence emerged of colistin resistance with the potential for transfer and spread between bacterial species. In order to preserve colistin for human medicine and limit the spread of resistant genes, the European Medicines Agency imposed strict limitations on its use and recommended the withdrawal of marketing authorisations for all oral colistin in veterinary medical products. Professor Galloway, from the Royal College of Physicians and Surgeons of Glasgow, is calling for a full review of the use of antibiotics used in both animal husbandry and human clinical practices, and I believe the Government should actively consider that suggestion.

In the UK, some sectors have conclusively beaten the target set by the veterinary medicinal products directive. Such industries represent very clearly what we are aiming for with the SMART targets I referred to at the beginning of my speech. In many cases, progress has been made through voluntary schemes. I request that the Government look directly into specific sectors in order to investigate best practice and what we can learn from it.

However, we must go further as a global leader and recognise that this is an international challenge. Almost 80% of antibiotics used in the USA are not taken by people but used within the livestock sector, which I find astonishing. In India, people consume an average of 11 antibiotic tablets per year. Only today, data has been released showing that antibiotic resistance is growing in Europe. Progress that Britain makes will be quite simply irrelevant in the absence of a confident international stewardship programme.

The British Government must act as an example in their commitment to tackling resistance head-on globally and, while I recognise it is not in the specific gift of my hon. Friend the Under-Secretary of State for Health to dictate his published ministerial responsibilities, I believe it is timely explicitly to add antimicrobial resistance to those responsibilities. That symbolic act would send a clear message that Britain is committed to remaining at the forefront of the fight against antibiotic resistance.

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

I share the hon. Gentleman’s concern about the problems with antibiotics, which we see with farm animals. However, there is also now a problem over supply, due to the increased concentration of the pharmaceutical industry—there are new mergers coming along as we talk. Does he think that that is worthy of proper investigation? Those companies can turn the supply on, but they can also turn it off, which can also be life threatening.

[Julian Sturdy]

The hon. Gentleman makes a fair point. As I said, we have to encourage new antibiotic discovery. In our current system, the big pharmaceutical companies have been reluctant to come forward and put that money in, because the financial model just does not work.

However, encouragingly, we are now seeing smaller companies and spin-outs—from science departments within medical departments within universities—looking specifically at antibiotic discovery. There is something to be said about that, and again we have to look closely at it, because it could be used to our advantage. I encourage the Government to look at that, I encourage all Members who have a university in their patch to talk to them and I encourage those who have any of these small companies to visit and talk to them. It is incumbent on us all as parliamentarians to go out there and promote what is happening on our doorstep.

There is no doubt about it: the big pharmaceutical companies are finding it very difficult to promote new antibiotics. It takes 15 years for a new antibiotic to come to the marketplace from the start of the process of discovery. Companies have to make a huge investment. If that investment leads to a drug that is not actually used, because we are using it as a point of last resort, the financial model as it currently sits just does not stack up. That is something we have to address.

The discovery and development of antibiotics should not be seen as a curse. However, we must recognise that responsible steps now need to be taken to ensure that they persist and that we keep resistance firmly locked down. The antibiotic age can remain a golden one, and our collaborative actions can prevent a fall into what has been described by many as a medical abyss without antibiotics.

In the antibiotic age, we are all on the same side. This is not about politics or what the UK can do; it is about global action. That cannot translate into a lack of zeal and an absence of the will to win. I very much look forward to hearing what the Minister has to say. The UK Government have made great steps forward. The O’Neill report was a great start, but we have to continue that, and we have to be world leaders in this. We have a great opportunity to do that, if not for our generation, for future generations.

Oral Answers to Questions

David Drew Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

It is essential in very rural constituencies such as my hon. Friend’s that we continue to have active GP surgeries; I notice that they sometimes give the best care in the whole NHS, because they know patients and their families and there is continuity of care. They are incredibly important for the local community, so I congratulate my hon. Friend on what he did to save that practice.

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

Is it right that constituents in Stroud now have to wait weeks to get an ordinary appointment with their GP? The sustainability and transformation partnerships are now saying that there is going to be an acute shortage of GPs. What is the Secretary of State going to do about it?

[Mr Hunt]

No one should have to wait weeks for a GP appointment in Stroud or anywhere else. We have a lack of capacity in general practice, which is why we decided to embark on a plan to get 5,000 more doctors working in general practice. That is one of the biggest ever increases in the capacity of general practice. I am afraid that it will take time to feed its way through the system, but we are confident that we will deliver it.

Mental Health Units (Use of Force) Bill

David Drew Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Mr Reed]

My right hon. Friend is absolutely right. The idea of engaging with the Welsh Assembly as the Bill proceeds through this Parliament is an excellent one, and I hope to have his support in doing so.

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

I congratulate my hon. Friend on the Bill. I declare a non-pecuniary interest in that my son is a community psychiatric nurse, although not a practising one. Does my hon. Friend agree that we need to look at the wider process of how people are taken into care? The sectioning process under the Mental Health Act 1983 does not allow any accountability to the victim. Does he agree that while the Bill is important, it needs to be seen in the wider context of how we deal with someone—at their most vulnerable—when they have been sectioned?

[Mr Reed]

I very much agree with my hon. Friend. The Government are commissioning a much wider review of mental health services. I hope it will encompass the points he raises, but that would be for the Minister to clarify.

The Bill will make sure that every mental health provider has a policy in place governing the use of force, including a clear deliverable plan for reducing its use, and ensuring that staff are properly trained in equalities and the de-escalation techniques needed to avoid the use of force. It will speed up justice and allow learning to take place by making sure that any non-natural death in a mental health unit automatically triggers an independent investigation, and making sure that recommendations from investigations and inquests are taken into account when improving mental health services in ways that currently do not happen.

The Bill is a significant step forward for our mental health services, moving them from the containment of patients to the care of patients. It will make sure that people with mental ill health are treated with compassion, not cruelty. There is overwhelming support for the Bill across the mental health sector. I am grateful for the practical support I have received from INQUEST, in particular its director Deborah Coles, and from Raju Bhatt, the widely respected solicitor who has represented so many bereaved families following deaths in custody. I am grateful to YoungMinds UK, Mind, Rethink Mental Illness, Agenda, the Labour Campaign for Mental Health, my hardworking staff and the Croydon North Ethnic Communities Forum. Also, 38 Degrees hosted an online petition that has been signed by over 60,000 people to demand this change.

--- Later in debate ---

[Mrs Trevelyan]

I thank the hon. Lady for her intervention, with which I absolutely agree. I am pleased that the number of people being held in police cells has fallen dramatically in the past few years, but, as we have seen this week, if people feel that they are suffering injustice, they should always take it to the police or, if that is where the problem or inappropriateness lies, find another outlet to be heard and to get redress. Every citizen of our country should always feel able to stand up and say, “This was wrong, and I am seeking redress for what was done to me.” I encourage the hon. Lady to support her constituent in seeking redress.

Many constituents have written to me with deep concerns about the effect that the undue use of force might have had on their child—and, in three harrowing cases, the effect that it has indeed had. One constituent detailed how the use of unreasonable restraint had a lasting effect on the health not only of the particular family member but on the whole family, which created years of trauma and ongoing illness. The use of excessive force can lead to long-term damage, and, as in the tragic case highlighted by the hon. Member for Croydon North, a death is an absolute travesty. We can never allow such abuses to take place in our civilised society.

It is good that cases of such terrible treatment are rare and that the numbers are coming down, but if we ever treat with force and brutality people who desperately need our help and support when in a state of mental ill health and distress, it is time for those voices to be heard and for action to be taken. These abuses cannot go unanswered or be tolerated any longer. The movement towards understanding mental ill health is progressing, and the Bill will help to change practice.

With that in mind, I will address two specific issues that are extremely close to my heart: autism and young people. There has previously been a lack of cross-Government co-operation on mental health issues. If we are to make a real impact on this issue and to change cultural norms, we need to ensure that the Department of Health, the Home Office, the Ministry of Justice and NHS England have closer working practices to deliver the necessary detention reforms. I hope the Minister will confirm that to the House later today.

The Bill could make a real difference in tackling the inappropriate force that is too often used against patients, many of whom are on the autism spectrum. A recent freedom of information request discovered that there were 66,681 recorded instances of restraint in England in 2015-16, an increase on the previous year. The use of physical, mechanical or face-down restraint can undermine an individual’s recovery and increase their risk of injury and long-term harm. As a society, we should be charged with protecting and helping those people to get well again.

I would hope that many in this House have read the National Autistic Society’s recent report “Transforming Care: our stories”. The report follows 13 families with a family member who is on the autistic spectrum or who has a learning disability and who is at risk of being admitted to an in-patient mental health hospital, of which there are still 2,500 across the country. One story spoke of a boy who was, according to a serious case review, “completely failed”:

“A very vulnerable young man suffered a sequence of traumatic experiences which may adversely affect him for…years.”

I am the mother of an autistic young adult—he has just turned 18—and I have other family members who are now diagnosed, and I am constantly concerned that the invisibility of autism in so many sufferers means that their mental health, or mental ill health when it hits them, has completely failed to be understood or, indeed, identified in crisis situations.

I used to have to ask teachers at my son’s school who did not understand how his Asperger’s affected him, “If he had a broken leg, would you ask him to run up the stairs or to join in a football match?” They would look a little bemused, and I would say, “He is in a state of deep stress and trauma at this point. You are expecting him to sit quietly in a classroom and pay attention, as when he is in a state of wellness. This is not possible.”

Teachers committed a huge amount of time to helping him to be in the mainstream system, and it took two or three years to understand that the invisibility not only of autism but often also of mental ill health until a crisis hits means that society cannot see it. Unless we are particularly attuned to the individual sufferer, or indeed to a wider understanding and identification of what that means, we cannot help them. It is important that people charged with looking after those who may be in need have rigorous frameworks and training. Just as we would not ask a boy with a broken leg to play in a football match, we must not have similar expectations of those in mental health crisis.

What can we say when we hear such harrowing stories, which are much more tragic than we should ever have to hear, and have to imagine the tragedy that those families have had to go through? How do we react? The instinct can no longer be to allow things to continue. We need things to improve, but we cannot just make tweaks here and there. The House cannot ignore issues that need urgent attention and reform. I am glad the Government recognise that and are supporting the Bill.

These isolated cases are sadly too common, and NHS Digital figures show that autistic young people still have an increased risk of being unnecessarily and frequently restrained because they cannot express their anxieties and crises in the way that neurotypical people more often can. We cannot continue with outdated practices and restraints that severely endanger the most vulnerable, who need considerate, appropriate and constructive treatment programmes that meet the autistic individual’s needs.

The Bill includes provisions to turn that into reality and to reform practices in mental healthcare, and it highlights a number of concepts that our constituents expect of us, of the Government and of our public services right through the system. I will cover a couple of those concepts.

First, on transparency, every time restraining force is used in a mental health unit it will be recorded and fully detailed. This would allow people to know that if this happened when they were in a state of mental ill health, it would be recorded; often people are not able to think clearly in these situations. Where someone has a broken leg or a broken arm, their mental capacities are still functioning fine and they will remember if the cast was put on the wrong arm—they would notice that. However, people in a state of deep mental ill health are not always able to see the world clearly at that point, so to have that fully detailed record will make a big difference to empowering those sufferers to know that they are being properly looked after.

In all our major institutions, such as the police or the NHS, we need accountability in everything that is done for our constituents. That is no mean feat in practice. This Bill will mean that every institution will have to have a named individual responsible for policy on the use of force and implementation. Given the discussions this week in the House, it is perhaps prescient to have a named person to whom those in distress can go, safe in the knowledge that they will be supported, understood and given a fair hearing. That is so important.

[Dr Drew]

Does the hon. Lady accept that the named individual must be able to prove that they have been trained in handling these incidents responsibly and, particularly, that they have been retrained on a regular basis? One weakness of the units is that there is not only a lack of training, but certainly a lack of updating of people’s training.

[Mrs Trevelyan]

I thank the hon. Gentleman for his intervention, and I agree absolutely that we need to get the training right in the first place; understand unconscious bias, which we all invariably suffer from, not only in general life, but within the complex environment of mental ill health; and ensure that de-escalation techniques are learned and constantly reiterated. Such an approach would allow the extraordinary people who work in this sector to be supported, constantly reminded of things and given the right tools to ensure that they can look after our family members and our constituents when they are in these crises.