Baby Loss and Safe Staffing in Maternity Care

David Rutley Excerpts

Tuesday 25th October 2022 Westminster Hall

[Jill Mortimer (Hartlepool) (Con)]

I beg to move,

That this House has considered baby loss and safe staffing in maternity care.

I am honoured to begin this important Baby Loss Awareness Week debate about safe staffing in maternity care, which is imperative. I speak today as the co-chair of the all-party parliamentary group on maternity, but also as the mother of three children. I also speak today because of my three very different pregnancy and birthing experiences, which for me highlight the impact of different staffing approaches on pregnant women.

I lost my first baby in the very early weeks of pregnancy, and I was told by a very kindly midwife that sometimes you have to lose a baby to ripen the womb. This made me feel dreadful. I fought very hard not to grieve openly for that loss, because I felt guilty that I should not. Forgive me: I am full of cold and dosed up, so I will get very emotional.

My first experience of birth 30 years ago was, as it is for many first-time mothers, a long and painful labour. I was persuaded to have an epidural; I think the words were, “You need Slick; he’s very good. Call for Slick.” When it is your first baby, you do not know how labour should feel. You think, “It’s worse for me than everybody else, because I am in so much pain.” So I took the epidural. I was then left for long periods without being checked. There were not many staff on the labour ward that night, and I was in a room on my own with my husband. I was told that when I got nearer they would remove the epidural, because I would need to push.

Sadly, but thankfully, it was only when, unbeknown to me, my son was crowning and in distress that the midwife happened to look in for a check. I had to have an emergency episiotomy and an emergency forceps delivery, which resulted in me having a really severe post-partum haemorrhage, and I nearly died. I remember looking at my new baby in the arms of his father and thinking, “They’re safe; I can go now,” and then I blacked out.

My second son was an extremely large baby, at almost 11 lb, but this was not picked up and he basically got stuck—

[David Rutley (Macclesfield) (Con)]

A whopper.

[Jill Mortimer]

He was a whopper; he still is a whopper. It caused long-term damage to my pelvis but, worse, he has had to battle his entire life with learning difficulties caused by a lack of oxygen at his birth. He was a floppy, quiet baby, and at 18 months he was diagnosed with, among other things, hypertonia. All his development was delayed, and he did not walk or speak until he was nearly two. I worked with him, and I am so proud that he kept battling on learning how to learn. Today, at 27 years old, he is training to be a nurse. [Hon. Members: “Hear, hear!”]

It was only during my third pregnancy that I experienced continuity of care, which was wonderful. The ability to build a relationship with my midwife, who stayed with me throughout my pregnancy, labour and beyond, was invaluable. I did not have to go through my story with new people all the time and had someone I came to know and trust by my side. I was lucky enough to experience that and wish more women had that chance.

Despite the benefits of continuity of care, I look back on the pregnancy and birth of my daughter with mixed emotions, because there should have been two of them. Very early in that pregnancy I again started to bleed. I bled with my first son and ended up spending a week in hospital, with people saying to me, “Don’t worry, it’s very early on; you’ll have another baby.” I lay still for a week, I did not breathe, and I kept him. But this time I started to bleed again, and I miscarried my daughter’s twin. I did not know how to feel or how to grieve, while having to put all my efforts into sustaining my pregnancy, fearful every day that I would lose the baby I still carried. I was lucky that my beautiful daughter was born safe and healthy, but that loss never goes away. With each milestone, I reflect on how they should be celebrating together. There should be two of them.

--- Later in debate ---

[David Rutley (Macclesfield) (Con)]

Thank you for the chance to say a few words during this important debate, Mr Davies. There have been hugely moving contributions and testimonies from my hon. Friends the Members for Hartlepool (Jill Mortimer) and for Hexham (Guy Opperman)—he and I have been friends for many years, and we are with him in his loss and with all others experiencing such real sadness. We are fortunate in Macclesfield to have support groups, such as Smile Group, that provide help for people having difficulties during or after pregnancy and, no doubt, we have groups that help people during baby loss as well.

We have heard moving and important contributions about the importance of greater consistency in standards, which I completely support. Maternity services are highly valued in our communities. In Macclesfield, our maternity unit was temporarily closed during the pandemic over two and half years ago. It is one of just a few maternity units that is still temporarily closed, and it is greatly missed by parents, and mums and dads who are expecting babies. I am working closely with the East Cheshire NHS Trust and the Cheshire and Merseyside integrated care board to ensure that the unit reopens in line with Government policy—it is Government policy to reopen temporarily closed units—and with the trust’s ambitions in April next year. The unit is vital, as it provides reassurance to parents and the full range of maternity services, including support for baby loss, locally in our community. I would welcome the Minister’s support for the reopening of this much-loved maternity unit.

In closing, let me say again how grateful I am for these contributions across this Chamber. The debate has helped to highlight a vital issue that we need to talk more about and provide more support for.

NHS and Social Care Funding

David Rutley Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

The whole issue comes down to sustainability, which is obviously the idea behind the sustainability and transformation plans. As those who have heard me speak about STPs will know, I support the idea in principle. The idea is to go back to place-based planning on an integrated basis for a community. The difference in Scotland is that we have focused on integration. We got rid of hospital trusts in 2004, and we got rid of primary care trusts in the late 2000s—in 2009 or 2010. Since April 2014, we have set up integration joint boards, where a bag of money from the NHS and a bag of money from the local authority are put on the table and a group sit around it and work out the best way to deal with the interface and to support social care. Anyone in the Chamber or elsewhere with family members who have been stuck in hospital will know that people get into a bickering situation: Mrs Bloggs is in a bed so the local authority is not interested, because she is safe there, and the local authority is instead busy with Mrs Smith, who has fallen off a ladder trying to put up her curtains and who is not considered safe because she is leaving the gas on. Such boards get rid of all that perverse obstruction.

[David Rutley (Macclesfield) (Con)]

The hon. Lady is making an important point, and I welcome the tone that she, unlike the shadow Secretary of State, has brought to this debate. She makes the point that the integration of care—social and health—is important, but does she agree that, with further devolution to the sub-regions and major cities in England, there is a huge opportunity to move forward that agenda south of the border?

[Dr Whitford]

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, so that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals; we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

Children’s Wellbeing and Mental Health: Schools

David Rutley Excerpts

Tuesday 10th January 2017 Westminster Hall

[Rebecca Pow (Taunton Deane) (Con)]

I am delighted to serve under your chairmanship, Mr Nuttall. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate, which is so important and timely, and I am pleased to be able to speak in it. I noticed last week that the debate was going to take place and I started to prepare my comments then, but of course, in the light of the Prime Minister’s excellent and welcome speech yesterday, I have had to change them somewhat.

I think it is pretty much agreed across the House that we need to put more emphasis on mental health, putting it on a par with physical health, as we have heard. We also need to do much more work on removing the stigma that seems to be attached to mental ill health, especially among young people. Another universally agreed principle is that prevention, or at least early intervention, is much better than cure. Obviously, that is where the school environment can really come into its own, and where I truly believe we need to focus a lot more effort.

To be positive for a moment, many Members from across the House have worked on bringing to the Government’s attention the fact that we needed a fairer funding formula for our schools. I am delighted that that is happening, and particularly that rural areas, such as mine in Somerset, will receive a much fairer share of funding per student. Although that will not solve mental health problems, it will alleviate the situation for many schools. They will have slightly more money to go around, which may mean that they have money to pay for consultants, advisers and specialist services, should they need them, for mental health. That is just one small thing, but if there is better education across the board, that has to be better for children growing up.

We know that a vast amount of mental health problems begin at school age, with 50% of lifetime diagnosable illnesses beginning at the age of 14, so it makes perfect sense to start dealing with those at that young age. I want to point out some positive initiatives that we could learn from and that perhaps should be copied on a wider scale. One is community engagement and involving young people in activities so that they really feel part of something. To give an example, I was very proud to go to the recent Somerset elections to the Youth Parliament in my constituency, where I was really taken by the assuredness of the students. Not only were they having great fun, but how well they conducted themselves, and how interested they were in life! I got talking to the chap who runs that—Jeff Brown from Somerset County Council—who said, “You should see the state that some of these children come to me in, when they are quite young—about age 11—and how this involvement, engagement and working together has really changed and helped them.” He also said that many of them had mental health issues, so if we could encourage children to get involved in such areas, it would be very helpful. Obviously, that means that we have to keep giving funding to organisations such as the Youth Parliament.

Another area that I am especially interested in, given my gardening and environmental background, is schools that are running gardening and outdoor projects to involve children in activities out of the classroom. I recently went to North Town Primary School in Taunton Deane; it has an excellent, innovative gardening set-up for a primary school. It is really involving children and giving them an outside interest—especially those who, perhaps, are not so academic—in growing and in watching the seasons change, watching nature and watching wildlife. The Royal Horticultural Society has many statistics to prove that that has a really beneficial impact on people’s mental health, and anything that any schools can do to get involved in such projects is worth while and to be encouraged.

Similarly, the Somerset Wildlife Trust, of which I am a vice-president—I am very proud to work with it—does an awful lot of work with local primary and secondary schools, enabling children to connect more with nature and the outside. According to national wildlife trusts’ statistics, 93% of schools said that outdoor learning improves people’s social skills, and 90% of children said that they feel happier and healthier when they are doing these activities outside. Interestingly, 79% of teachers in the surveys that they did said that outdoor learning had a real impact on their teaching practice, so I think there are real lessons to be learned there. Those are all excellent examples of what has already been done.

When I met the people from YoungMinds, they stressed the importance of placing wellbeing and all the activities that I have mentioned alongside academic learning. Again, I welcome what the Prime Minister said, and I was especially pleased to see that a review will be done of child and adolescent mental health services; I hope that it will begin swiftly.

Now for my negative bit: in the south-west, young people’s mental health is a significant issue. I am sure that all Members could give examples; I have many from my casework. People come to me with heart-rending stories exactly like the one that the right hon. Member for North Norfolk told about his daughter. I could list handfuls of people who are affected, including my children’s school friends, my son’s sports mates—guys with aspirations—and neighbours’ children. It is absolutely shocking how many people we can think of offhand. It is not only awful for the child; it puts so much pressure on families, especially if they must go long distances for treatment. It is awful for the child and awful for the parents, but it is also difficult for other siblings to carry on a normal life, and for parents to bring up all their children. I do not know if the right hon. Member for North Norfolk has other children, but I know that the impact makes things difficult for siblings. This is a serious issue, and this House and the Minister need to deal with it.

I welcome the introduction of mental health first aid training in schools, but will the Minister liaise with the Department for Education on an issue relating to the budget cuts for sixth-form colleges? In Taunton Deane, we have an outstanding sixth-form college called Richard Huish College, which has just been shortlisted to be The Times Educational Supplement’s sixth-form college of the year. I wish the college well in that, but when I spoke to its principal, he told me that the school had had to cut all its enrichment courses: sport, drama, music. He was at pains to stress that we need to send the message that we should not expect children to excel only at academic things such as maths and English. Obviously, those are important, but there are other ways for children to show that they are good at something, and for us to celebrate what they do. He pointed out that it is often the children who do not get such opportunities, or who think that they are not good at anything, who fall into a trap and start on a downward spiral. That is how we end up with a spike in mental illness. I urge the Minister to go along to the Department for Education and see whether we can have a bit of joined-up thinking.

I am delighted by the renewed focus on children’s mental health, especially as children spend a third of their time in school. Much good is already being done, as I have pointed out, and I would like to see some of those models copied, especially the ones relating to outdoor activities, the environment and even sport. Some schools run a daily mile; I believe that started in Scotland. Pupils go outside at a set time every day with their schoolteachers, in whatever they are wearing, and run a mile. They might get a bit sweaty, which I believe the girls do not like terribly—

[David Rutley (Macclesfield) (Con)]

My daughter does.

[Rebecca Pow]

—although my hon. Friend’s daughter does. What a terrific idea. If everybody does it, nobody worries about what they look like. It is simple and cheap; it does not cost a penny. I will also throw in that on Radio 4 this morning, we heard about shared family meals. There is so much benefit in things like that.

To conclude, I stress that the long-term benefits of addressing mental health issues at an early age will be to everybody’s advantage. I applaud the Government for what they are doing, but it is just the start—the building blocks or foundations on which I hope we will build a better future, in which we do not have to debate this issue.

--- Later in debate ---

[David Rutley (Macclesfield) (Con)]

It is a pleasure to serve under your chairmanship, Mr Nuttall; it is the first time I have done so. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate. During his time in office he really helped to highlight the challenges in mental health and he continues, quite rightly, to put the spotlight on mental health now. We are all grateful to him for the work that he has done in this area.

It is clear—obviously partly because of the Prime Minister’s speech—to all of us who have tried to make some efforts on young people’s mental health over the last year that it has become a major issue. For me, it became absolutely clear that it was a critical issue around 18 months ago, when I had a group of about 10 young people come to Parliament for an induction day. In a gap in the Q and A session, I decided to ask them what they thought was the most pressing challenge that their generation faced. In unison, those 10 young people, who were studying for their A-levels and had great prospects ahead of them, did not talk about tuition fees or debt; they talked about mental health. They said that mental health is the challenge we need to deal with.

As I started to explore this area in more detail, I went to an event at a school—it was a Christmas party, I think—and spoke to one of the parents who happened to be involved in dealing with pupils with pastoral issues in another neighbourhood. She talked about the increased incidence of self-harm, particularly among young women, which the hon. Member for Bridgend (Mrs Moon) mentioned. I then had the chance to speak to a number of children who were not actually dealing with mental health challenges in their own life but who were really worried about how they could help their friends who were. They were coming home and asking, “How do you deal with a friend who is involved with self-harm, or who is considering it?” Trying to come up with those solutions is a heavy burden for a 12 or 13-year-old, so these issues need to be tackled urgently.

I am grateful to YoungMinds for the work it is doing. As I have spoken with its chief executive, Sarah Brennan, and her team, it has become clear that mental health is now not just a challenge for the one in 10 children who we have heard about, or the one in 12 to one in 15 children who are dealing with self-harm; the latter figure could even be higher, according to the hon. Member for Bridgend. It is clear that young people’s mental health is a growing challenge. It is not just static; it is growing. Therefore, because of the increase in the number of referrals and because of the challenges that exist—from talking to my local mental health service provider, Cheshire and Wirral Partnership, I know that they exist—we must tackle the issue. As I have said in previous debates, the issue is amplified by social media. Feelings of low self-esteem and low self-worth need to be tackled and we need to help build resilience.

Although, obviously, not everything has been done yet, the Government took an important step forward with the “Future in mind” report, and credit needs to be given to the Prime Minister for her efforts and for the initiatives she put forward yesterday: mental health first aid training for teachers and staff; a thematic review by the Care Quality Commission, with Ofsted support; a new Green Paper on children and young people’s mental health; and the absolutely key aim—it has not been mentioned in this debate but we must ensure that it is delivered—that by 2021 no child will be sent away from their local area to be treated for general mental health disorders. My hon. Friend the Member for Bury St Edmunds (Jo Churchill) highlighted that concern. The Prime Minister was honest enough to highlight that treatment is only part of the answer. What we need to do now is prevent mental health challenges and build resilience.

Something else that has not been mentioned today is the important investment of nearly £68 million in digital mental health services to provide online therapies. It is absolutely critical that we can multiply the expertise out to as many people as possible, making it easily accessible through digital technology.

In the couple of minutes I have remaining, I want to highlight what else we need to do next. We need to learn from best practice. Peer-to-peer support does not cost a huge amount and we need to ensure that we do it. The Emotionally Healthy Schools programme in Cheshire East has been particularly helpful. We must also ensure that there is counselling support and space available at school.

I know that you are keen for me to wind up, Mr Nuttall, but let me just say one thing in conclusion. We need to ensure that the digital funding that is available pushes forward recognition for greater support from social media themselves. Often social media are a cause or an amplifier of mental health challenges. We must ensure that easily accessible apps are in place to support these young children.

Finally, given what the Prime Minister has said, it is time for our various third sector charities to come together with a clear set of asks for the Government and a clear plan of action that they would like to see us take forward; YoungMinds, the National Society for the Prevention of Cruelty to Children, Barnardo’s and all organisations that have clear expertise bringing to bear a clear plan of action that will deliver for those young people who are suffering and those we do not want to see suffer in the years ahead.

[Mr David Nuttall (in the Chair)]

I ask the Front-Bench spokespersons to restrict their comments to nine minutes, so that we can leave a couple of minutes for the mover of the motion to wind up at the end.

Accident and Emergency Services: Merseyside and Cheshire

David Rutley Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh (Southport) (LD)]

I beg to move,

That this House has considered accident and emergency services in Merseyside and Cheshire.

It is a pleasure to serve under your chairmanship, Sir Roger, and a pleasure to see the Minister in his place. We spent many a happy hour on the Public Accounts Committee in years gone by, and I have great respect for him. I am sure he will give due consideration to what I say.

The debate title is a slight misnomer, however, because it was intended to entice other colleagues from the Cheshire and Merseyside region. Sadly, they have not taken the bait, perhaps because of the limited time available, so I will talk largely and almost exclusively about my own patch.

Southport is a large seaside town on the Lancashire coast, with one of the most elderly populations in the UK. I have to point that out, because for some reason I am often confused with the Member for Stockport and I am referred to as such. Southport, however, is nothing like Stockport. Southport is a seaside town and has one district general hospital on a split site with Ormskirk. The accident and emergency provision, though, is split by age between the two sites, which is a bone of contention in Southport.

For the purpose of the sustainability and transformation review, Southport was grouped with other hospitals ringing Liverpool, including those in Aintree, St Helens, Whiston and Warrington. Southport has recently had a poor Care Quality Commission report on its A&E department and an equally poor review of its surgery. It has responded positively with further investment of £600,000 into the A&E department, so that now, according to the stats—I checked this with the chief executive only this week—it has one of the best-performing A&E departments in the north-west.

That might have been the end of the story, because the CQC report dates from some time back and because of the improvements, but for suppressed drafts of the Cheshire and Lancashire sustainability and transformation review that have been leaked. The leak showed a number of things, including a possible downgrading of Southport A&E and of other A&E departments in the area—the hon. Member for Macclesfield (David Rutley) is now in the Chamber, and his is one of the areas affected, as we have discussed—as part of a cost-saving exercise.

That is not the first time that the suggestion has been made apropos of Southport, but the Minister knows from his own experience in Ludlow how politically explosive such suggestions can be and have been. He will also appreciate that those suggestions are sometimes entirely simplistic and often linked to another further bright suggestion that people come up with, which is to close down wards. The consultants charged with balancing the books, and often deferred to by the national health service, might come up with the brilliant suggestion that the best thing to be done with a loss-making hospital is to get it to do less—to stop admitting people to A&E, and finding space for them in wards, and therefore to close down A&E and shut down a few wards.

The Cheshire and Merseyside sustainability and transformation plan proposals were reneged on somewhat in the final draft, so they fell short of actually advocating downgrades. However, that is not to say that that is not in mind as an ultimate objective.

[David Rutley (Macclesfield) (Con)]

I congratulate the hon. Gentleman on securing the debate. Like him, I am concerned about the proposals set out in the STP and, with regards to east Cheshire, the document actually sets out that options being considered include downgrading from an A&E to an urgent care centre in Macclesfield. There needs to be greater transparency about the options and a frank conversation with people. There is already a Macclesfield petition signed by 8,000 people opposing any downgrading of A&E services in our area.

[John Pugh]

There is also a petition in Southport, and I am sure there will be petitions wherever in the country this sort of thing happens. As the hon. Gentleman suggests, the ownership of the sustainability and transformation reviews is wholly unclear. No one quite knows who writes the plans, or how they are agreed, and few democratically elected bodies or people, or patients, have any kind of input. In fact, the Liverpool local authorities wrote in some indignation to the authors of the report to ask, “How can we be involved? It alleges in your report that we are involved, but we do not appear to be.” Furthermore, no one quite knows why the hospitals have been grouped as they are.

Southport hospital is in a particularly unfortunate position, because it has changed its chair recently and suspended its chief executive over a period of a year, so it is unclear to me how Southport and Ormskirk’s views could have been represented in any review. Roadshows were organised by the clinical commissioning groups to talk about the financial plight of the local NHS and things that need to be done, and I have attended some of them, but they spend all their time talking about things such as savings on prescriptions and none on the big league stuff that is agreed and discussed in NHS boardrooms. There is absolutely no transparency, and I am sure hon. Members share in my cynicism. We await the real cost-saving proposals—or, in some cases, the empire-building proposals that are often disguised by blather about clinical efficiency and safety, which come almost after the event.

I speak with some cynicism, because I am a veteran of such carryings-on. I regret all the back-stage manoeuvres and, in particular, that no one has been around to champion my local hospital in the review. There is a good case for keeping our A&E—elderly people throughout the country are the major clients of A&E, for obvious reasons.

Young People’s Mental Health

David Rutley Excerpts

Thursday 27th October 2016 Commons Chamber

[Tim Loughton]

I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.

Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.

I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.

I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.

Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.

Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.

Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.

[David Rutley (Macclesfield) (Con)]

Will my hon. Friend give way?

[Tim Loughton]

I will of course give way before I say something indiscreet.

[David Rutley]

I am sure that my hon. Friend would never saying anything indiscreet. He always makes important observations in such debates. He and I were at school together, and if bullying or similar was going on, children left their problems behind when they left school for the day. Does he agree that the challenge today is that such problems go home with the child beyond the school gates and during the holidays? Does he agree that digital service providers should take further steps to provide apps and protections that will help children in those difficult circumstances?

[Tim Loughton]

I do agree. Believe it or not, my hon. Friend is older than me and was in the year above me at school. He has aged rather better than me, but then he has not been in the House quite as long as I have. He is right about the dynamics of the stresses and strains in those days. How children communicate has also changed. For example, one of my daughters once put in her request for supper by text message from her bedroom to my wife and me in the kitchen—supper’s off! In an age when communicating has never been easier with email, social media, mobile device, tablet or whatever, the irony is that face-to-face communication between human beings has never been more rare or remote. Therein lies part of the problem. Communication between children and parents does not happen as regularly, and the fault lies with the parents as much as the children. Some people cannot talk frankly about the real pressures, strains and stresses on our children and about grooming, sex matters or drugs. In my hon. Friend’s day and my day, we perhaps talked more to our parents or other family members.

I will now pick out a few points from the report—I know that other hon. Members want to speak. We have reached a point at which one in 10 school-age children will have some form of mental disorder, and the age at which that happens is getting younger. Some 340,000 five to 10-year-olds have a form of mental disorder. If it is not detected early and acted on, it just festers and gets worse. Too often, the only immediate response if someone gets access to a clinician is the chemical cosh of drugs, which is in many cases inappropriate for younger children. Talking therapy, for example, might be more appropriate, but we increasingly find that when people have to wait weeks or months for them a call has to be made between waiting longer or giving some form of antidepressant.

The report flags up the big issue of the transition from childhood to adulthood. Nothing changes physically or mentally when someone receives an 18th birthday card from their Member of Parliament. The last thing that an 18-year-old needs if they are going through the stresses of mental health is to have a completely new process and system to deal with because they have suddenly become an adult even though their condition has not changed. There is a particular issue around children in care, who too often used to leave at the age of 16. Fortunately, we now have a new scheme, which I was proud to have piloted at the Department for Education, based on staying put, allowing for a longer lead-in time. Every child is different and different children will be ready to go into the big wide world at different ages. The report contains some good examples of best transition practice. Southampton general hospital has a 0 to 25 age range for its “Ready Steady Go” scheme, under which every person is treated differently—people have different “go” ages.

Turning to the report’s recommendation about GP training, it is right, certainly for younger children, that GPs will be the first port of call for clinical services. Training for GPs to deal with younger people’s mental health problems is not good. Young people may need a lot of confidence to go along to see a GP with a parent or whomever, and there must be a clear understanding of how to tease the best out of children, so we need better guidance. As the hon. Member for Dulwich and West Norwood mentioned earlier, young people should absolutely be in on the genesis of that guidance.

Another recommendation that we have heard a lot about relates to what happens in schools. The hon. Member for Dulwich and West Norwood quoted the National Association of Head Teachers briefing, which states:

“When children do not meet CAMHS thresholds, schools often become responsible for children’s mental health.”

In too many cases, they are ill-equipped to do so. We are dealing with potentially one in 10—three in a class of 30—children suffering from some diagnosable mental health disorder, and the chief medical officer says that three quarters of them will receive no treatment at all. That will obviously have an impact on the child, but there will be an impact on the class as well and it is very much in the school’s interest to do something about that.

We need better teacher training so that they are able to identify the signs that point towards a mental illness. They also need better awareness of where to signpost children to get the treatment that they require. They should also be able to talk about things more generally in class. We can argue whether PSHE should be compulsory—I have some sympathy with that—and whether mental health should be a formal part of it, but it must be done in an environment in which young people will feel engaged. It should not be just another lesson, but a place where they feel free to talk openly, to absorb and to learn.

Oral Answers to Questions

David Rutley Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

The reason we made the decision to proceed with the new contracts is that we had independent advice that a negotiated settlement was not possible. On that basis, we decided that it was important to have certainty for the service by making clear what the new contract is. The contract that we decided on is one that strikes a mid-point between what the Government wanted and what the BMA asked for. It is a fair contract and a better contract for patients. The Labour party would support it if it was really on the side of patients.

[David Rutley (Macclesfield) (Con)]

5. What steps the Government is taking to improve support for children and young people with mental health problems.

[The Minister for Community and Social Care (Alistair Burt)]

The Government are committed to delivering the vision set out in “Future in mind” and are driving forward a major system-wide transformation programme, working alongside our partners in Government and arm’s length bodies to improve access to high-quality support across the country.

[David Rutley]

I thank my right hon. Friend for the steps he has set out. Will he join me in congratulating the charity YoungMinds on the important work it does in highlighting the mental health challenges young people face, not least from the so-called dark net and social media. Does he agree that we must ensure that the internet is a positive and not a negative force in tackling young people’s mental health challenges?

[Alistair Burt]

Yes, the work that YoungMinds and a range of other partners have done and continue to do to ensure that children and young people can access information safely is commendable. Children, young people and their parents have expressed the need to access both high-quality and reliable information and support online. That was reflected in the “Future in mind” report on children’s and young people’s mental health. We are investing with MindEd and a number of groups and organisations to work on apps for young people. It is important that they have access to safe material to exclude that which is rather darker.

Childhood Obesity Strategy

David Rutley Excerpts

Thursday 21st January 2016 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

I will stick to my eight minutes, Madam Deputy Speaker, and I will not give way, if that helps—[Interruption.] All right, I will give way.

It is a pleasure to follow the hon. Member for Colchester (Will Quince). He is hard on himself; he is not obese, just very well built. I know that his enthusiasm for curry is known throughout Colchester, so that might be a contributing factor. It is a pleasure to speak in the debate and I congratulate the hon. Member for Totnes (Dr Wollaston) not just on how she chairs the Select Committee on Health but on how she brings issues to the House, especially this critical issue of childhood obesity. I am delighted to see the Minister at the Dispatch Box, as she gets it. She is the Minister responsible for diabetes and whenever we in the all-party group on diabetes ask her to deal with these issues, she has always been very open and transparent. I think that she is on the same page as the rest of us.

That helps me put aside at least half of my speech because I do not need to repeat the statistics that Members who are experienced in these matters know all about—the cost of diabetes to the national health service, the worry that over half a million people have type 2 diabetes and are not aware of it, the need for prevention and awareness, and the importance of protecting our children. The figures given by the hon. Member for Totnes are clear. The problem gets worse as children get older and the figures are so worrying that if we just stand still, the crisis of childhood obesity will continue.

[David Rutley (Macclesfield) (Con)]

With reference to standing still, the debate today has largely focused on sugar and our intake of it. One of the key things we need to do to tackle the challenge of childhood obesity is to focus on activity—getting people to be physically active, through sport or, as I increasingly believe, outdoor recreation. The Department for Culture, Media and Sport sports strategy, which focuses more on outcomes and includes outdoor recreation, could help to tackle the crisis that we are facing. Does the right hon. Gentleman agree?

[Keith Vaz]

Absolutely. The hon. Gentleman is looking at someone who constantly tells people to move more, but prefers to go by car rather than walk. It is a wonderful thing to say, but it is a different matter to get us on to those bicycles, on to our feet and involved in physical activities. My physical activity extends to table tennis, which is not the best way of losing weight and ensuring that my type 2 diabetes is under control. The hon. Gentleman is right—those lifestyle changes are necessary and they need to happen at a very young age. Schools, teachers, kids and parents need to be involved in ensuring that there is more activity because that will help in the long run.

We should be pretty dramatic in the way we deal with the problem. As you know, Madam Deputy Speaker—as you have no doubt shown the film to your children at some stage—Mary Poppins thought that a spoonful of sugar helped the medicine go down, but a spoonful of sugar, or nine teaspoons of sugar in a can of Coca-Cola, does not help the medicine go down—it makes matters worse.

In the short time available, I shall concentrate on the need to ensure that retailers do their bit to bring down the sugar content in sugary drinks. I am full of praise for the Mayor of London, the hon. Member for Uxbridge and South Ruislip (Boris Johnson), for going one step further than waiting for a sugar tax, which I understand is still on the agenda. There was a feeling that the Government had rejected that, but there were newspaper reports that the Prime Minister was still considering the matter. Perhaps the Minister can tell us when she winds up.

The retailers, having been invited by the previous Secretary of State for Health to be part of a voluntary arrangement, did not keep their side of the bargain. Despite the great declarations that were made by the previous Secretary of State, which I am sure were well intentioned, it is difficult to control global empires to ensure that they reduce the amount of sugar in drinks. We therefore have to take drastic measures. That is why I support a sugar tax, as enunciated by the Chair and other members of the Health Committee. We need to do that. We also need to do what the Mayor has done. Putting up the price of sugary drinks in City Hall is an extremely important way of sending out a clear message. Simon Stevens has said that he would do the same thing at NHS hospitals. How many of us turn up at local hospitals and see vending machines openly trying to sell us sugary drinks such as Coca-Cola?

I recently returned from a holiday in India. Whenever I asked for water or Diet Pepsi or Diet Coke, I was told it was not available. There is an interesting read-across to other Government Departments. The big retailers may be more conscious of the fact that the British House of Commons is interested in the issue, but in countries outside western Europe and the United States, they may feel that they can dump their sugary products without offering an alternative. Before we get to the issue of the sugar tax, which, as I said, I support, there is much that retailers can do.

I recently visited a branch of Waitrose in West Bromwich. I was interested to see that all the sugar-free products had been put in one kiosk in the middle of the store, so when people walked in they were not overwhelmed by the promotion of two-litre bottles of Coca-Cola for the price of one—they looked at the kiosk, where there were only no-sugar products. That is a way of encouraging those who purchase—I am not saying dads do not do it, but in most cases mums—to go to the kiosk and try to think positively about buying products that are free of sugar.

As I said in an intervention, there are things we can do. If we go to the Tea Room to have our lunch after this great debate, what is on offer? Club biscuits, Jaffa cakes, the most fantastic Victoria sponge—marvellous stuff that the Administration Committee offers us. The fruit is at the side, between the refrigerated drinks and the till. By the time I get there, even I, with my type 2 diabetes, am sometimes tempted to go for the sugary products and the chocolate. Why do we not promote the food and drinks that are healthy?

That is why, like others, I commend what Jamie Oliver has done. We need people like that, who have captured the imagination of the British people, to ensure that the public and the press help in the efforts to reduce sugar. Finally, I lavish praise on my hon. Friend the Member for Swansea West (Geraint Davies), who has introduced a Bill to provide for better labelling. We still do not have effective product labelling. It is important that we see such information because it will enable us to make informed choices.

If we do nothing, the obesity crisis will get much worse. We are not drinking at the last-chance saloon. That is now closed. We are outside and we are ready for firm Government action. That is our request to the Minister. Because of her own commitment to these issues, I know she will react positively.

Mental Health

David Rutley Excerpts

Wednesday 9th December 2015 Commons Chamber

[David Rutley (Macclesfield) (Con)]

The hon. Lady is of course right that this subject is vital. The Government are working hard on it. Will she join me in welcoming the Government’s promise and commitment to bringing in an extra £600 million for mental health services, as set out in the autumn statement?

[Luciana Berger]

My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.

--- Later in debate ---

[David Rutley (Macclesfield) (Con)]

It is an honour to follow the hon. Member for Edmonton (Kate Osamor) who made some important points.

I will focus my brief remarks on young people with mental health issues. Every year I am privileged to bring about 10 young people into Parliament for a parliamentary induction day, and during a question and answer session I asked what were the biggest challenges facing them and their generation and peers. I thought that the answer would be about how to get into, and fund, a place at a decent university, but all 10 of them said in unison that mental health was the biggest challenge they faced.

I found that staggering, and given the various cases that I have had to deal with as an MP, I have taken a much closer interest in the subject and worked hard to find out more about the issues relating to young people. Clearly, the challenge is increasing. In the Cheshire and Wirral Partnership NHS Foundation Trust alone, referrals have gone up by 25% over the past couple of years. There is growing awareness of the issue, which in many ways is a good thing.

It is also clear that social media amplifies those challenges, and I ask those who have brought the likes of “Assassin’s Creed”, and other weird-sounding computer games, to the young people we work with, to please use that creativity and ability to communicate with young people to develop digital approaches that will help them to feel more comfortable about who they are, and about their place in the real world and the digital space. There is a responsibility there.

I am pleased that we will hear from the Minister for Community and Social Care, who takes a keen interest in this area. Extra funding is being used to tackle issues on the ground, and we are seeing best practice with young advisers in our area helping to youth-proof local services. Our Emotionally Healthy schools programme is bringing together an integrated approach to that vital part of our community.

Cities and Local Government Devolution [Lords] Bill

David Rutley Excerpts

Wednesday 21st October 2015 Commons Chamber

[Mr Betts]

There is a big difference in the Manchester case. I am not arguing that Manchester should have a mayor imposed on it. If Manchester wants that, that is a matter for it, but it is different. In Sheffield we have hybrid devolution, with transport going to the mayor, but the mayor is not going to cover the nine districts. The mayor will cover only four districts—the old south Yorkshire districts—so how are people to understand the devolution deal, which has one set of governance arrangements for economic powers and skills, and another set of governance arrangements for transport, where one set of governance arrangements covers four authorities, whereas the other set covers nine?

The whole purpose of combined authorities is to bring local authorities together on a voluntary basis to cover a travel to work area—the natural economic entity—yet transport, the mayor and the associated powers will not cover the whole travel to work area of Sheffield. This is a real dog’s dinner. It is not going to work, and it is certainly not going to be understood by the public.

That leads me on to my second point. There is a problem with mayoral imposition, which in Sheffield’s case will not cover all five areas. Other districts can choose to join the arrangements for mayors if they wish. My understanding—I may be wrong—is that the districts of north Derbyshire and north Nottinghamshire, which are part of the Sheffield city region, are going to join the combined authority, which they are part of, for the economic powers. However, for transport powers to be devolved to those areas through a mayor, those districts will not merely have to agree, but they will have to get the county, which is the transport authority, or two counties, to agree as well. Does the county have a veto over what happens to devolution in the Sheffield city region?

This is not workable. At the same time as the Sheffield city region has a mayoral possibility, Derbyshire and Nottinghamshire are looking at having a joint combined authority, which would have a mayor as well. As I understand it, the mayor can exist for the districts of north Derbyshire and north Nottinghamshire only if those districts agree to the county mayor for Derbyshire and Nottinghamshire being created. So they have a veto over that. At some stage, surely, Ministers have to take some responsibility for coming forward with proposals to sort out this mess, or it will stop devolution working effectively in these areas.

[David Rutley (Macclesfield) (Con)]

As the hon. Member for Macclesfield on the other side of the Pennines, I understand the hon. Gentleman’s concerns and enjoy working with him on the all-party parliamentary group on national parks. Does he agree that one of the fundamental points of having a mayor is to achieve clear accountability? The lesson from London is that probably the greatest accountability the Mayor has is for transport. At a local level, surely much of the work needs to be done to bring the partnerships together. It cannot all be imposed by the Minister. It has to be about dialogue, which may sometimes be uncomfortable, at a local level as well.

[Mr Betts]

I understand that argument, and it would be a lot easier to accept it from the Government if there was clear accountability and a clear understanding of what was happening, and if I had not just had to explain the situation in Sheffield city region, which has neither clarity nor accountability. Transport arrangements are to be devolved to a mayor who does not cover the whole travel to work area. That is not clarity or consistency, and it will not work.

Big issues are involved. I see the hon. Member for Carlisle (John Stevenson) in his place. We had discussions in the Select Committee, of which he was a valuable member in the previous Parliament, and I know he has clear views about moving towards unitaries if we are to have a combined authority that works. Otherwise we will have districts, counties and combined authorities, as well as parishes in some areas. I am not sure that that amounts to easy-to-understand government. The hon. Member for Amber Valley (Nigel Mills) has raised some interesting issues. I am not sure about his solution, but there is a problem, for which Ministers have to accept some responsibility.

I realise that others wish to speak. On the amendment tabled by my hon. Friend the Member for Nottingham North, I hope the Government will listen to the idea of some sort of independent body to look at these issues. That was discussed by our Select Committee last time. If there is genuine disagreement between central Government and local government, an independent body could bring the two sides together and produce a report for Parliament to consider. In the end it is not just about Government agreeing these deals; it is about Parliament taking a view where there is disagreement. Even if Ministers are not minded to accept the amendment today, it is an interesting idea to which they might give some thought.

Finally, we cannot legislate for double devolution because in the end, devolution has to allow areas to do things their own way, but there is a role for Ministers, parliamentarians and the LGA to get the message across that devolution does not stop at the town hall door. Where powers are devolved to local authorities, it is for them to move those powers into communities and to engage with communities in a positive way to make devolution happen even further down the line.

--- Later in debate ---

[David Rutley]

I have great respect for my hon. Friend, who is indeed a great friend. Like him, I would absolutely love to see devolution succeed in Greater Manchester, in partnership with authorities in the counties around it, including East Cheshire unitary authority.

[Mr Brady]

I am glad to have enabled my hon. Friend to speak for himself.

Amendment 42 seeks a very simple and not terribly onerous change. It would simply require the Government to report annually on how they have exercised their functions in order to demonstrate that they have not themselves exercised any of the devolved functions that rightly belong with the combined authority or the mayoral authority. There might be better ways of doing this, and I hope that my hon. Friend the Minister will put forward his own proposals in due course. However, the underlying point is that although the Government have been very pleased to place obligations on local authorities through the process of forming agreements or deals, as the Secretary of State likes to term them, very little in the Bill as it stands provides any mechanism to hold the Government to account and ensure that they fulfil their side of the bargain. I think that would be welcomed by everybody who is an evangelist for devolution—as I am sure we all are.

The Minister alluded to amendments 43 and 44, which seek to provide an easier route for exit. I happily accept that, as the hon. Member for Denton and Reddish (Andrew Gwynne) said, it would be very difficult for any authority to leave a combined authority, especially a mayoral authority, at some point in the future. An enormous number of functions, agreements, financial obligations and so on will bind local authorities together, increasingly so as the years pass, and therefore no local authority would do this lightly. However, the ability to leave, should the devolution arrangements not work in practice for any one or more of the local authorities in an area, is, in some ways, the ultimate guarantee that no abuse should take place. It is particularly important that we should have such a safeguard if we reach the end of our deliberations without a referendum lock in place. If the public are not to be given the choice as to whether they want to have the elected mayor and this new structure of governance put in place over them, surely there must be a safeguard so that if, at a future date, the new arrangements were not working for the people of Trafford, Bury, Stockport or Bolton, they could seek to leave, without penalty, to find a new way of providing services and representation to the local community.

Amendment 51 calls for a referendum test to be passed. This also relates to Government amendment 4. I think the only reason the Government are so determined to overturn the amendment passed in another place which seeks to prevent conditionality—local authorities being told they are allowed to have devolution only if they accept the model of an elected mayor as a condition—is that negotiations in Greater Manchester have moved as far as they have under those conditions. It seems wrong that the Government are expecting local authorities to accept a particular model of governance as the price for this kind of devolution settlement, particularly if the Government do not have the self-confidence to consult the people and to believe in their own argument such that they could persuade the public that it is something they ought to welcome. This is the ultimate test of the Government’s arguments. The Minister is a very persuasive man, as we have seen in the Chamber today. I am certain that with his enthusiasm, charm and powers of persuasion, he could go out and sell this proposition to the people of Greater Manchester, and perhaps to those in Sheffield and other parts of the country. I wish that he would have the confidence in his own abilities that we all have.

Child and Adolescent Mental Health Services

David Rutley Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

Again, I gently make the point that we all, on both sides of the House, have to recognise the need over the next five years to make better use of the resources available. The hon. Lady’s own party does not propose ring-fencing local authority funding for the provision of mental health services at the lower tier level. We all have to work on making more effective use of the money, and I genuinely think that the taskforce is an opportunity to modernise how we organise services, particularly commissioning—having four different commissioners does not create the best chance of co-ordinating services.

[David Rutley (Macclesfield) (Con)]

Like many in the House, I recognise the Minister’s commitment to this important issue. I speak to young people and teachers, and there is a growing recognition of the importance of mental health services for adolescent children. What research has the Minister undertaken to better understand the root courses of the mental health challenges facing young people today, particularly the impact of social media?

[Norman Lamb]

My hon. Friend is right to highlight an emerging and growing phenomenon causing increased distress for some young people. The prevalence survey, for which we now have the funding for 2015-16, is a massive opportunity to understand much better the scale of the problem we are seeking to deal with.