Paterson Inquiry

Jackie Doyle-Price Excerpts

Tuesday 27th March 2018 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

On 7 December 2017 the hon. Member for Ludlow (Philip Dunne), then the Minister of State for Health, announced an independent, non-statutory Inquiry, under the Chairmanship of the Right Reverend Graham James, Lord Bishop of Norwich into the circumstances and practices surrounding the former breast surgeon Ian Paterson, who was convicted in April 2017 of wounding with intent and unlawful wounding.

Since then the Bishop has worked with affected families to ensure their views are taken into account in shaping the terms of reference.

Today, I can announce the terms of reference for the inquiry, which will report in summer 2019.

The remit of the independent, non-statutory Paterson Inquiry will be to:

Examine and seek to learn from what happened to former patients of Ian Paterson, both in the independent sector and in the NHS informed by their experiences and concerns; and

Review the circumstances and practices surrounding Ian Paterson as a case study, and consider other past and current practices, so as to draw conclusions in relation to the safety and quality of care provided nationally to all patients.

The inquiry will consider issues raised in previous relevant reports about Ian Paterson, but does not intend to revisit the evidence that led to his conviction.

A central objective of the inquiry is to afford former patients of Ian Paterson and their families an opportunity to tell of their experiences and to be heard.

The inquiry will aim to report its conclusions and recommendations by summer 2019. It will publish its report and the Secretary of State for Health and Social Care will make arrangements for its presentation to Parliament.

This announcement marks the beginning of the important work of the inquiry in listening to the experiences of former patients and gathering other evidence to ensure that the independent healthcare sector and the NHS are able to learn the lessons from Ian Paterson’s appalling malpractice that has taken or damaged the lives of so many people who invested their trust in him.

It can also be viewed with the Terms of Reference at: http://www.parliament.uk/writtenstatements.

[HCWS589]

Phenylketonuria and Kuvan

Jackie Doyle-Price Excerpts

Thursday 22nd March 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank my hon. Friend the Member for Cheltenham—

[Vicky Ford]

Chelmsford.

[Jackie Doyle-Price]

I am sorry—I ought to know it is Chelmsford because my hon. Friend is a near neighbour of mine, and I thank her for the passionate and articulate way that she made her case this afternoon. I am proud that it is I who am responding to her first Adjournment debate, because she and I go back a long way. I hope to give her some comfort from the fact that we are taking into consideration some of the issues she has raised today. I also thank the hon. Member for Strangford (Jim Shannon) who made an articulate pitch on behalf of the families of those who suffer from rare diseases. We must always remember that we are dealing not just with the person who has the condition, and that the burden on their family can often be as great, if not greater.

My hon. Friend has secured this debate on phenylketonuria and its treatment with Kuvan, and she set out some concerns on behalf of all PKU patients, which I hope to address. The importance of addressing rare diseases, of which PKU is one, is increasingly recognised by policy makers and healthcare service providers, not just in the UK but worldwide. Mercifully, the numbers of patients suffering from each rare disease can be small, but collectively 3.5 million people in the UK alone are affected by rare diseases. To put that number in context, 1 in 17 people will suffer from a rare disease at some point in their life.

The Government are dedicated to improving the life of patients with rare diseases, and that is laid down in our promise to implement the 51 commitments of the UK strategy for rare diseases, which includes the need to take account of new evidence that may emerge as a result of research and development.

Many rare diseases are present at birth or soon after and PKU is no exception. We understand that PKU has an estimated prevalence of one in every 10,000 births. We know that without treatment early in life the outlook for those born with PKU is very poor. Without appropriate treatment, as my hon. Friend outlined, people will develop severe learning disabilities which may lead them to require constant care. With treatment, however, the outlook can be good. Screening therefore has a vital role in early and accurate diagnosis. The current new-born screening programme in the UK is based on the blood spot, or heel prick, test and screens for nine rare conditions, including PKU. Treatment can then start straight away, minimising the risk of serious complications. As I understand it, for patients with PKU this treatment includes a special diet, confining intake to low protein food and regular blood tests, as my hon. Friend explained.

I recognise that this protein-restricted diet can be very limiting and particularly difficult for children to adhere to. Young patients with PKU cannot eat many of the enjoyable foods that we all eat each and every day, such as meats, milk, cheese and fish. That undoubtedly puts a strain on patients like Cait and their families—I am very pleased that they are here witnessing the debate today—and can make simple day-to-day activities such as going to school or meeting friends a significant challenge. I also appreciate the immense pressure it must put on parents and carers to deny a child the pleasure of choosing and eating a wide range of food on a daily basis.

We all understand the desire of young patients to live a regular life, and eat any food and not have to worry about consequences. However, because of the extremely limited number of naturally low phenylalanine foods available to PKU patients, mainly fruit and vegetables, they also need supplements to meet daily energy requirements, add bulk to their diet and increase variety. My hon. Friend outlined some of the protein shakes they have to rely on to do that. The availability of low-protein foods and nutritional supplements through the NHS is still very important and has, since its development by Birmingham Children’s hospital in the 1950s, saved the lives and improved the outcomes of many PKU patients.

Let me move on to address the specific point my hon. Friend made about Kuvan, which has been found to lower blood phenylalanine levels in some patients with mild or moderate PKU. As highlighted today and in previous debates, this drug is unfortunately only effective in some patients. It is entirely dependent on their particular genetic make-up and is more likely to benefit those with the milder forms of PKU. In those cases where patients respond to treatment with Kuvan, it means they are still likely to be required to continue with some form of dietary restriction.

NHS England currently has a policy on the use of Kuvan for the management of PKU during pregnancy. It is targeted at PKU patients who are not able to establish low levels through dietary control alone. Keeping mums-to-be safe is of great clinical importance to prevent maternal PKU syndrome and lifetime adverse consequences for their babies, the worry of which may further increase a mother’s anxiety around pregnancy and the worry about the developing baby.

The reason why Kuvan is currently not routinely commissioned for use in children and adults is the lack of evidence of its effectiveness on nutritional status and cognitive development at the time the policy was developed in 2015. However, if doctors treating a patient think they would benefit from treatment with Kuvan, clinicians are able to make an individual patient funding request, as my hon. Friend said. I appreciate that what my hon. Friend is asking for today is a bigger change than that, beyond access for an individual patient—namely, a wish to see a change to the commissioning policy on Kuvan for use in children and adults that respond to the drug. As I mentioned in my opening remarks, it is important to take account of new evidence and developments as they emerge. I am happy to report that NHS England has received a preliminary policy proposal for the use of Kuvan in the management of PKU for adults and children, as new evidence has now been published to support its use. That was considered by the clinical panel in January, where it was agreed that NHS England should undertake a further review. NHS England is now working with NICE to agree the best approach and has asked it to consider developing advice on the use of Kuvan. I hope that my hon. Friend accepts that this is a positive step in the right direction.

I also agree with my hon. Friend about the need for good stakeholder engagement. Taking stakeholder views into account is vital in any decision-making process. That will involve members of the public and patients, including Cait and her family, as well as all families this will have an impact on. I was very pleased to hear make the point about BioMarin, the manufacturer of Kuvan, being open to negotiation on the pricing of the drug. That is extremely welcome news. Indeed, as part of any review process, manufacturers will be able to offer a patient access scheme to NICE, and the price offered is then considered to determine the cost-effectiveness of a drug.

I hope I have reassured the House today that the discussion on access to Kuvan is actively being considered. The Department will follow the upcoming work by NICE and NHS England with great interest as they consider the impact of new evidence on commissioning policy. I emphasise that research is crucial to improving our knowledge of rare diseases and to working towards better treatment of them, and I am pleased that the UK is recognised as one of the leading countries for research into rare diseases. In July 2017, the chief medical officer published her landmark report, setting out a vision for genomic medicine in the UK.

The Government have accepted the report in full and responded with the establishment of a national genomics board chaired by my colleague, Lord O’Shaughnessy. I hope that this reassures my hon. Friend and the House about the Government’s commitment to supporting research, aiming to bring real change to the way we understand and treat rare diseases. We are in a fantastic position in the UK, at the forefront of that science, and our patients play a vital role in challenging us as policy makers, healthcare professionals and researchers to find new treatments for the benefit of all.

In conclusion, we will ensure that we harness the remarkable prospects that these new developments present for the benefit of our rare diseases patients. We will look more closely at Kuvan. NHS England and NICE will review the new evidence and will engage with BioMarin to consider whether Kuvan should be made available more widely.

I am very grateful once again to my hon. Friend for highlighting these issues. In closing, perhaps through her I can extend my very best wishes to Cait and her family as she battles with this disease.

Question put and agreed to.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 20th March 2018 Commons Chamber

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

22. What estimate he has made of the number of young people who have not had access to child and adolescent mental health services after a referral in the last 12 months.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

We estimate that of the approximately 460,000 referrals made to children and young people’s NHS mental health services per year, 200,000 children receive treatment and many are appropriately signposted to other help. Treatment within the NHS is determined by clinical need and it is vital for all to remember that specialist services are not always appropriate for those referred. That said, we are committed to treating 70,000 more children and young people each year by 2020-21.

[Anna Turley]

Around one in 10 children and young people in Redcar and Cleveland has a mental health disorder—a proportion that is higher than for the rest of the north-east and higher than for England. Local services are becoming overwhelmed. Last year, Redcar charity The Link, which provides mental health support for children, experienced an increase in demand of 40%. It has a waiting list of over 140 children and planned waits of 11 weeks, but the charity is still having to make redundancies and staff have had their hours cut due to the funding crisis. Will the Minister commit to increasing and ring-fencing spending for child and adolescent mental health, and will she ensure that the role of third sector charities in delivery of such services is preserved?

[Jackie Doyle-Price]

Having looked at the performance of the hon. Lady’s local trust, I can say that it is rising to the challenge extremely well, but that brings with it challenges. We are increasing the funding available for children and young people’s mental health services. We are relying on local clinical commissioning groups to purchase those services, but I can tell the hon. Lady that NHS England will be keeping this area under scrutiny, to ensure that we are delivering that help to the frontline.

[Vicky Foxcroft]

Does the Minister accept that cuts to mental health services mean that too many young people who have suffered trauma are not getting the support that they desperately need? Has she measured the impact of that on young people, and looked, in particular, at any links to the tragic incidents of youth violence that we are now seeing daily?

[Jackie Doyle-Price]

I do not accept the allegation that there have been cuts. We have increased expenditure by 20%. We recognise that we need to invest significantly more in improving children and young people’s mental health, and that is exactly what we will be doing.

[Andrew Bridgen (North West Leicestershire) (Con)]

Mental health problems clearly have a wider societal cost. Does the Minister agree that treating mental health issues in children benefits not only the child, but the future of our society as a whole?

[Jackie Doyle-Price]

I could not have put it better myself, and this is exactly why we have brought forward the proposals in the Green Paper. We recognise that early intervention is the best way of protecting people’s mental health, so we will be encouraging all schools to appoint a designated mental health lead. We will be rolling out mental health support teams to support schools and we will be trialling a four-week waiting time standard. This will lead to a material improvement in children’s mental health.

[Paula Sherriff (Dewsbury) (Lab)]

The Care Quality Commission has reported that young people are waiting up to 18 months to receive vital treatment. The Royal College of Psychiatrists says that some health trusts are spending less than £10 per child on mental health services and that spending today is less than it was in 2012. So will the Minister tell us exactly what she is doing to fix what many health professionals say is a broken child and adolescent mental health services system?

[Jackie Doyle-Price]

I welcome the hon. Lady to her place on the Front Bench. I believe this is the first time we have had exchanges, and I am sure it will not be the last. We invested an additional £100 million last year. We know that more than half of providers have an average waiting time of fewer than 12 weeks and 4% of providers have a waiting time of fewer than four weeks. She is right in that six trusts are outliers and they are receiving significant attention from NHS England. We are having targeted work with them to address what might be the issues there. As I said earlier, as part of the Green Paper we will be trialling a four-week waiting time standard, and we are determined to achieve improvement in this area.

[Sarah Jones (Croydon Central) (Lab)]

11. If he will make an assessment of the potential merits of employing youth intervention workers at major trauma centres.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I fully support the role that youth workers play in supporting vulnerable young people. We are working with the Home Office, which supports the charity Redthread to develop its work embedding youth workers in hospital emergency departments to intervene with young victims of violence. Redthread currently operates in London’s four major trauma centres, and will be launching in Nottingham and Birmingham this year. Redthread is also working with academics to assess the impact of its youth violence intervention programme.

[Sarah Jones]

Knife crime continues to soar, and Members from across this House believe that we need a new approach. Having youth workers in hospital A&Es is proven to work, and, as the Minister says, Redthread is in some of our hospitals around the country. It would cost as little as £6 million a year to put youth workers into all our major trauma centres, so will she find the funding?

[Jackie Doyle-Price]

First, I commend the hon. Lady for the work she does on tackling knife crime and I know it is an issue close to her heart. The work with Redthread is being co-ordinated with the Home Office, and I would not want to allocate its expenditure, any more than it should be allocating mine.

[Edward Argar (Charnwood) (Con)]

12. What steps the Government are taking to support Dementia Awareness Week.

Psychosis: Early Intervention

Jackie Doyle-Price Excerpts

Thursday 15th March 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is fitting that you are in the Chair for this debate, Mrs Moon, given your interest in these matters. I am grateful to the right hon. Member for North Norfolk (Norman Lamb) for securing this debate. It is always with some mixed feelings that I face him across the Chamber, not least for the reasons that the hon. Member for Liverpool, Wavertree (Luciana Berger) pointed out. However, this has been an extremely well-informed debate on both sides. I have not disagreed with very much of what has been said. It is great to respond to such a passionate debate, among people who genuinely care about the issue.

The right hon. Gentleman is absolutely right that improving access and waiting times for early intervention in psychosis must be a top priority. I will set out some of the things that we are doing, which I hope will reassure him of the direction of travel. He is rightly holding us to account on where we are. I quite agree that it is not good enough, and assure all Members who have participated in today’s debate that I am not complacent in any way about any of this.

First, I want to set the context. The hon. Member for Liverpool, Wavertree often challenges me that we have not achieved parity of esteem. I do not pretend that we yet have, but we have embarked on a genuinely transformational programme to raise the treatment of mental health issues to parity with physical health. However, that is essentially a cultural change, which will take time.

I want to set out that we do have a plan, to reassure the hon. Member for Stockton South (Dr Williams). We have now got to the stage in that plan where we have to be a lot more outcome focused, and really get to the grit of what is happening on the ground. As the right hon. Member for North Norfolk set out, there is widespread regional variation. We have to ensure that we are not only increasing access, but doing so in a consistent way. There are lots of challenges in doing that. People have raised the issue of the workforce. Obviously, we cannot magic up a workforce overnight, but there are plans to address that issue.

The right hon. Gentleman mentioned the Secretary of State’s weekly meetings where we interrogate health officials. I assure him that we are reviewing each individual mental health trust to scrutinise their performance, and the Care Quality Commission advises us on a weekly basis about that performance. I assure him that it is improving—it has massively improved, in fact—but there is still more to be done.

When we bring in standards and targets, the risk is always that we build in perverse incentives, and that institutions can game the system. Until the data we collect is embedded properly, there will be some risk of that, but we have to be on it. I acknowledge the right hon. Gentleman’s pivotal role in introducing those standards, and all his work in Government to drive this agenda. Having inherited his mantle, I look forward to him continuing to challenge me to deliver what he set in train.

Given that time is short, I want to home in on what we are doing to implement the waiting time for early intervention. The latest data that we have shows that we are exceeding the target of 50% for access to early intervention in psychosis services, with more than 70% of patients starting treatment within two weeks in the most recent quarter. I know that the right hon. Gentleman has rightly raised concerns about his freedom of information request on mental health trusts. Only 29% of 49 trusts that returned the request could expressly confirm that they were able to deliver the full NICE-concordant packages of care to their patients. To reassure him, the moment at which he made his request was at the start of the programme.

[Norman Lamb]

It was this year.

[Jackie Doyle-Price]

It was measuring the kick-start of the programme. I would hope that if the right hon. Gentleman repeated that in a year’s time, he would get a very different picture. I assure him that we are making progress, but I invite him to continue his scrutiny, because sunlight is the best disinfectant, as I often say.

The hon. Member for Stockton South asked whether we had a plan. We do. The issue is that our plan is often based on inputs and structures. It is only when we get the kind of analysis that the right hon. Member for North Norfolk applies that we can see whether an input is really delivering the outcome that we want. Using our tools of leadership, we are now ensuring that we are holding everyone’s feet to the fire to deliver those standards, and that we are actually implementing the plan that we have in place.

To give some detail on what that plan is, we are investing an initial recurrent £40 million per annum for EIP in clinical commissioning group baselines. That will rise to £70 million recurrently by 2021. I have heard the message loud and clear from all hon. Members that they want to be reassured that that money is reaching the frontline. We will go away and think about how we can best illuminate that. We are funding clinical networks in all regions to provide clinical leadership for implementation, and to support local efforts across the country. Those networks provide a great deal of support on sharing best practice, training and innovation. Quite often, sharing best practice can be the best way of driving improvement.

We are investing in a national team to co-ordinate regional teams and to support the monitoring of delivery through the regions. We are developing the data set to illustrate how much progress we are making and how the interventions are being delivered to people. That will allow commissioners and providers to prioritise how they develop and improve their services in line with the National Institute for Health and Care Excellence guidance. What is especially welcome is that there is now a recognition of the link between mental and physical health in NHS England’s work, although we have to continue to build on that.

The hon. Member for Liverpool, Wavertree rightly raised the issue of support for new mums. I am glad to hear that she has visited mother and baby units, as I have. Seeing the reality of that treatment shows how important that service is. We continue to prioritise investment in tackling post-partum psychosis. We are investing £365 million into those services, and are currently looking at issuing contracts for four new mother and baby units. She asked me some specific questions about the number of beds. I will write to her on that, because although it might seem like a simple question, it is slightly more complex. As she has rightly highlighted, it is a very vulnerable time for new mothers. We must ensure that we have services available across the country, as we still have some geographical discrepancies in the level of provision. I highlight the fact that we are putting more support for new mums in the community, based around the whole ethos of early intervention. I think that is extremely important.

I could say an awful lot more, but I promise hon. Members that all those who spoke in today’s debate have given me many things to think about, and I will reflect on them. I look forward to debating all these measures regularly. It remains the Government’s priority to deliver a step change in how we provide services for poor mental health. That is a cultural change, and it will take time. That is why we have it as a five-year forward view. We will make the investment in additional staffing resources to deliver that step change, but I have no doubt that all hon. Members in this room will continue to hold my feet to the fire to make sure that we deliver.

Points of Order

Jackie Doyle-Price Excerpts

Wednesday 7th March 2018 Commons Chamber

[Mr Speaker]

I have certainly not been advised of any intention on the part of a Minister to make an oral or, indeed, written statement to the House. There is a Health Minister on the Treasury Bench, who has heard what the hon. Lady said. She is welcome to respond if she wishes, but is under no obligation to do so.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

indicated dissent.

[Mr Speaker]

Not at this time. I say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who is an experienced denizen of the House, that there will be opportunities through the business question and subsequently for her to draw the attention of the House again, and perhaps in more detail, to her concerns and to elicit a ministerial reply.

Accutane

Jackie Doyle-Price Excerpts

Wednesday 7th March 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Sir Roger, and to respond to my hon. and gallant Friend the Member for Beckenham (Bob Stewart), who spoke movingly about the impact of isotretinoin on those who have an adverse reaction to it. He gave me a lot to think about, and I will reflect on the points he made.

It is worth reminding the House of the statement that the Secretary of State made only a couple of weeks ago about the review of medical products and devices, which comes on the back of similar concerns having been raised about other drugs and whether patients are properly advised of the potential side effects of those treatments. He announced that that review would look at three particular products, but also at whether we need to learn wider lessons.

My hon. Friend gave a good example of why we perhaps need to reflect on whether we think sufficiently about how we advise patients to best look after themselves. Our licensing and regulation process for medicines is very scientific and very much based on the product, but, as he explained, the impact of adverse reactions is on human beings. We need to ensure that we deal with these things in the most humane way, because there are real human impacts, which he powerfully outlined.

I welcome this opportunity to amplify the points that my hon. Friend made by providing an update on the risks associated with the use of isotretinoin and on what else we can do to advise patients of its potential side effects. Isotretinoin is licensed on the basis that it is seen as a highly effective medicine for the treatment of severe and resistant acne. Acne affects around 80% of adolescents at one time or another and can affect adults, too. Acne can have a significant negative impact on the lives of sufferers, and it can be very debilitating and distressing. Many forms of acne respond well to treatment with creams, ointments or antibiotics; isotretinoin is reserved for the most acute and resistant cases.

We estimate that 30,000 patients use isotretinoin each year in the UK. Worldwide, more than 18 million people have used the drug. For most people, a single course of treatment leads to the end of their acne, but, as with all medicines, there is the risk of side effects in some people. It is impossible to predict which individuals will suffer a side effect from a medicine. The most important thing we can do is to ensure that, when patients are prescribed a drug, they are fully aware of the risks associated with it so that they can make an informed choice. As my hon. Friend suggested, we are often talking about teenagers, whose stage of development means they are not best placed to make such an informed choice, so we also need to ensure that doctors and prescribers can have sensible and mature conversations with their patients and that we make all the information readily available.

It is worth saying that the risks and benefits of isotretinoin were carefully considered at the time of licensing. Because of the serious side effects associated with the drug, as outlined by my hon. Friend, it is licensed only for use in the most severe forms of acne that do not respond to other treatments. However, as he said, people can find it easy to track down medicines via the internet. Therefore, while we can put in place procedures to ensure that prescribers give the right advice, the opportunities to track down drugs via the internet remain, where such protections are not available. We therefore need to think about what to do through education. While our licensing system is a scientific process that is respected around the world, we need to consider properly whether we are doing enough to inform patients about how they should consider risk.

In Britain, isotretinoin can be given only under supervision of a consultant dermatologist, and it is generally dispensed via hospitals—however, my hon. Friend found it easy to identify a supplier. We need to ensure that prescribing decisions are made by healthcare professionals who have the most experience. We need to get the message out that, when it comes to these drugs, people need to take the advice of those properly qualified to give it. That does not include Mr Google.

My hon. Friend talked about the information leaflet for patients, which is included in all licensed medicines packs. That is an essential tool, but we need to ensure that people do read it. He mentioned that some supplies do not contain the most up-to-date guidance. That is because supplies are being worked through—all new stocks contain the up-to-date leaflet. We will, however, ensure that the Medicines and Healthcare Products Regulatory Agency continues to communicate that best advice to address some of those issues.

We really need to think more carefully about how we can ensure that patients are owning their treatment and properly assess whether they are considering the risks associated with using a particular medicine. I want to start a debate about the principle of informed consent. I am sure that, in the cases my hon. Friend outlined, had the risks of potential depression been properly communicated there might have been a very different outcome. They may have chosen to use the products anyway, but what is important is that patients make an informed choice, in full knowledge of potential side effects.

The MHRA continues to review side effects. The review of medicines safety is an ongoing process, which recognises that clinical trials will not always pick up every single side effect. The most common known side effect of taking this drug is dryness of the skin. That condition can be severe, chronic and debilitating in some patients, and that can exacerbate the depression that my hon. Friend alluded to.

My hon. Friend also referred to the risk of suicidal behaviour. We can debate whether there is a causal association, but it cannot be ruled out. It is complicated by the fact that young people with acne have an increased risk of depression before the additional effects of that treatment. We will continue to keep those side effects under review and disseminate the best possible information.

The national confidential inquiry into suicide and homicide by people with mental illness highlighted that health conditions were a theme, and within that acne was an evident theme in suicide. When someone—often people with conditions such as acne—has been diagnosed with depression, we expect the NHS to follow guidelines on the management of that depression, which include reviewing how they are interacting with any medicine they are prescribed. Again, we must ensure that that work is undertaken properly.

Isotretinoin is a highly effective medicine that has changed many lives for the better. However, as with any effective medicine, the benefit must be balanced against the risks, and decisions about prescribing and taking medicines need to be supported by clear and comprehensible information. Few here will not have known someone who has suffered physically or mentally with the scars of acne, but few, too, would doubt the serious nature of the potential side effects of this powerful medicine.

I should refer to the point my hon. Friend made about a possible association with male sexual dysfunction. Many reports have come to light through the UK yellow card scheme and similar reporting schemes worldwide. In the latest review, conducted just last year, there was sufficient cumulative data to add warnings to patient information about the possibility of experiencing lower libido, or problems getting or maintaining an erection.

The MHRA communicated information about those possible side effects to healthcare professionals in the UK in its drug safety update bulletin in October last year. It is therefore making efforts to raise awareness of the issue and support discussions with patients regarding their treatment. The issue is being closely monitored in order to gain more information about possible side effects and to try to establish whether there are any trends or particular at-risk patients. Although some patients recover after treatment is stopped, for others, as my hon. Friend outlined, the side effects have continued after treatment was completed. It is not clear from the available evidence how the medicine may be causing that problem, but the MHRA will continue to gather intelligence.

My hon. Friend also referred to the risk to unborn babies in the event that women get pregnant. Women taking this drug generally need to have a pregnancy test every month and use effective contraception throughout their course of treatment. That illustrates the awareness of risk management in that context, but we need to consider whether we need to do more to ensure that male users are properly informed of the risks.

I repeat that I am grateful to my hon. Friend for bringing this issue to my attention. I am concerned about the whole issue of informed consent of patients. The conversations that happen when drugs are prescribed are based on an asymmetry of knowledge and information. Perhaps in deference to medical expertise, we do not always ask the right questions when we are offered a treatment. Perhaps in deference to professionals’ expertise, we take it as given and trust that we are being given something that will make us better. However, we all know that, whatever drug we take, there is always a risk of side effects. Perhaps we should all, in our own way, use our voice to encourage patients to think widely about risk.

Let us be frank: there is risk in taking an aspirin or a paracetamol, and more sophisticated drugs carry even more risks. We would all be better at looking after our own health if we were prepared to have two-way conversations with medical professionals when we ask for their help so that we do not end up with the upsetting stories my hon. Friend shared with us today. I thank him for bringing the issue to my attention, and I will reflect on his comments.

Question put and agreed to.

Abortions in England for Women in Northern Ireland

Jackie Doyle-Price Excerpts

Tuesday 6th March 2018 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

On 29 June 2017, the then Minister for Women and Equalities wrote to MPs and informed them that women normally resident in Northern Ireland would no longer be charged for abortions received in England. An update informing the House of progress was given on 23 October 2017. The scheme is now in place and I am pleased to provide a further update.

The three main providers of abortions in England have been awarded grants by the Department of Health and Social Care to fund service provision in England for women resident in Northern Ireland. The cost of this service will be met by the Government Equalities Office with additional funding provided by HM Treasury. A small number of procedures will continue to be provided through the NHS where this is necessary for medical reasons. NHS providers will reimbursed by the Department of Health and Social Care.

Women from Northern Ireland seeking medical support in England are eligible for:

A consultation with an abortion provider in England, including an assessment of whether the legal grounds for an abortion are met;

The abortion procedure;

HIV or sexually transmitted infection testing as appropriate;

An offer of contraception from the abortion provider; and

Support with travel costs if the woman meets financial hardship criteria.

This is comparable with the experience that women in England receive.

We have established a central booking service that will be run by the British Pregnancy Advisory Service. The central booking service will simplify the process for women who choose to access these services. It means that women from Northern Ireland will have a single telephone number to call and an appointment will be made with the most appropriate provider, based on the woman’s requirements, her medical condition and the availability of the providers. The central booking service has been up and running since 1 March 2018.

This scheme does not change the position in relation to the provision of abortions in Northern Ireland. Our scheme does not include the provision of any services in Northern Ireland.

[HCWS511]

Mental Health Act: CQC Report

Jackie Doyle-Price Excerpts

Tuesday 27th February 2018 Commons Chamber

[Luciana Berger]

To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s report, “Monitoring the Mental Health Act in 2016/17”.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

The Government welcome the CQC’s latest annual report, which it produces as part of its statutory duty to monitor how mental health providers exercise powers and discharge their duties when people are detained under the Mental Health Act 1983. We are committed to ensuring that the Act works better for patients and their families, and this is why we have commissioned an independent review led by Professor Sir Simon Wessely, which will make recommendations in autumn. We are also investing more in mental health than ever before, spending an estimated record £11.6bn this year.

We have seen that the number of detentions under the Act has been rising year on year: it rose by 2% last year and by 9% the year before that. We also know that black people are disproportionately affected. These were both driving reasons for the Prime Minister’s decision to call for a review of how the entire Act is operating. The Government have already acted when they saw that the Act was not working properly. Last year, we legislated to make it illegal to use police cells as places of safety for children under the Act, and to ensure that police officers consult health support staff before using their detention powers.

Sir Simon, his vice-chairs and the independent review’s team are consulting actively and widely with service users and professionals, and today are taking part in a major stakeholder event in Newcastle. Indeed, I welcome the fact that the CQC takes care in its report to state: “We have confidence that the independent review’s solutions-focused approach to identifying priorities, based on the feedback and experiences of people across the country, will offer a review of the MHA that has the confidence of patients and professionals.” The CQC is, of course, directly involved in that review.

The CQC’s report found examples of good practice, but we recognise that more needs to be done to ensure that people’s voices are heard and their rights respected. Where possible, we expect all patients to be involved in their care planning and that providers should consider how best to do this in the light of the CQC’s recommendations. In the spring, the review will provide an interim report identifying priorities for its work. It will then develop a final report containing detailed recommendations on its priorities. This final report should be delivered by autumn 2018.

There are problems with the Act, and we will address them, but we should remember that today no one gets sent to an asylum only to disappear within its walls. There are regular reviews, clear rights of appeal and checks to ensure that people are lawfully detained only to get the treatment they need. Our society is changing how it thinks about mental illness, however, and we want to ensure that people have as much liberty and autonomy as possible.

[Luciana Berger]

This scathing report finds that too many patients subject to the Mental Health Act continue to experience care that does not fully protect their rights or ensure their wellbeing. Some Members might have seen the harrowing episode of “Dispatches” last week, which showed scenes of a patient experiencing violent restraint at the Priory Group’s Dene Hospital. Today’s CQC report indicates that these experiences are not isolated. It shows no improvement in key areas of concern raised by the commission in previous years. It is totally unacceptable. In fact, some of the indicators are getting worse. Why is there still no evidence of patient involvement in 32% of care plans—up from 29% last year; of patients’ views being recorded in 31% of care plans—up from 26% last year; and of consideration of the least-restrictive care options in 17% of cases—up from 10% last year? This last, in particular, is a matter of serious concern. We know that the period following discharge from in-patient care is when most suicides happen. Why, then, in 24% of care plans was there no evidence that plans were made for discharging patients back home?

The report exposes the pressure on high secure hospital placements for women. One patient was in long-term segregation for over a year while waiting to access a bed. The Minister, to whom I listened closely, referred to the review by Sir Simon Wessely, but his review and report cannot provide answers to this patient or many hundreds more across the country today. Despite repeated Government promises of parity of esteem, we have seen yet another year of inaction. Does she accept that, in 2018 here in England, what is outlined in today’s CQC report is completely unacceptable, and will she tell us exactly what she is going to do this week to ensure that no patient in our country in a mental health unit is deprived unnecessarily of their human rights?

[Jackie Doyle-Price]

It is worth reminding the House why we introduced the CQC—to provide for transparent inquiry into the performance of our health services and so ensure they remain the best in the world. It is for precisely this reason—to make sure we do better—that we invite the CQC to do so so honestly and take any criticism arising from the transparent scrutiny that characterises this and all its reports. We recognise that we can always do better. The duty of candour in the NHS under this Government means that we will step up to the plate and respond to these challenges.

The hon. Lady describes the report as “scathing”. In fact, it highlights a positive direction of travel on access to advocates and promoting good physical health, and an improved direction of travel on care after discharge, so I do not accept the tenor with which she characterised the report. I would go further and quote the deputy chief executive of the CQC, who also highlighted the parallel review by Sir Simon Wessely. He says: “We have confidence that the independent review’s solutions-focused approach to identifying priorities, based on the feedback and experiences of people across the country, will offer a review of the MHA that has the confidence of patients and professionals.” The report also highlights that Sir Simon Wessely is already undertaking and identifying actions that can be taken outside new legislation, and the CQC is very much part of delivering that.

Far from being complacent, we recognise that we have a long way to go, which is one reason the Prime Minister has put mental health firmly at the top of our health agenda. The report identifies a positive direction of travel, but we will continue to turbo-charge it and deliver sustained improvements in mental health services.

[Sir Desmond Swayne (New Forest West) (Con)]

Are there any proposals to address the fact that three quarters of GPs have no formal mental health training?

[Jackie Doyle-Price]

One of the things that we are doing in prioritising mental health is dealing with exactly that issue. We are having discussions with every part of the health community. We recognise that all the professional organisations have a role in spreading best practice, but we need to do that as well, and the CQC report—and the fact that we are undertaking these reviews so transparently—will help us to do it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Today’s report lays bare the problems that are at the heart of the Government’s short-sighted and incoherent approach to dealing with mental health issues. The CQC has found the system to be “under considerable pressure”, with no improvement in the areas of concern raised in previous reports.

Rather than taking a preventive approach to mental health treatment, the Government have made real-terms funding cuts which mean that more people are at risk of being detained and fewer detentions are being prevented. Crucially, those cuts are causing less restrictive alternatives for the community to be removed at the same time as the reductions in the number of beds for admissions. As the report tells us, the number of detentions under the Mental Health Act 1983 has risen by 36% since 2010, and between 2015 and 2016 it rose by more than 5,000. Will the Minister note that between 2000 and 2009 rates of detention fell, largely owing to investment in community services by the last Labour Government?

Recent research by the Royal College of Psychiatrists showed that mental health services have less money to spend on patient care in real terms than they did in 2012, and more than a quarter of clinical commissioning groups underspent their mental health budgets last year. The Government make many claims about the funds that they have pledged to mental health services—as the Minister has today—but it is clear that the money is not reaching the frontline. The CQC thinks that reform of mental health legislation on its own will not reduce the rate of detention, and reductions in mental health beds and community services are clearly contributing to the rise in the number of detentions. Is it not time to increase funding for mental health, and to ring-fence mental health budgets?

[Jackie Doyle-Price]

I repeat that we have increased mental health spending by £11.6 billion. The hon. Lady suggested that a quarter of CCGs are spending less than their allocations on mental health, but that is not the figure that I have. We believe that 85% of CCGs have increased their mental health expenditure in excess of their allocations, which does not chime with what she said about community services. It may give her some reassurance to know that from next year, NHS England will ensure that the mental health investment standard forms part of its planning guidance. [Interruption.] The hon. Lady says “Next year”, but, as I have said, 85% of CCGs are already meeting the standard, and those that are not are experiencing intervention from NHS England. We are satisfied that the 85%—and it will be 100% next year—are investing more in mental health services beyond their allocations.

I agree with the hon. Lady, and indeed with the CQC report, that the review of the Mental Health Act is not the entire answer. That is the reason for the CQC’s annual inspections, and we will act on its recommendations, but central to the work that Sir Simon Wessely is leading is identifying non-legislative action that we can take in order to make the system work better, and we are involved in many cross-Government initiatives that will enable us to do exactly that.

[Mr Philip Hollobone (Kettering) (Con)]

The report also concludes that the number of mental health wards without ready access to GPs has fallen from 25% in 2013-14 to just 7% now. Is that not welcome news, and another step in the right direction?

[Jackie Doyle-Price]

I thank my hon. Friend for that comment. He has highlighted both the reason why we tasked the CQC with conducting annual inspections and an instance in which, having been given a conclusion and a set of recommendations, we have delivered, and we will do the same in respect of this report.

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

The report makes clear the need for a major shift in focus that will place patients at the centre of their care. What is required is a human rights approach in which the least restrictive option is adhered to. Detention must be the last resort.

A key issue is that patients feel invisible in the present system. Will the Minister go to the frontline? Will she visit the hospitals, speak to the staff about resourcing, and speak to the patients and the carers who are in, and have been through, the system? Will she hold the focus groups that are so badly needed with patients and carers to ensure that the system is overhauled and their voices are heard?

[Jackie Doyle-Price]

The ethos that the hon. Lady has outlined is very much the one that is being proposed by Sir Simon Wessely, which is why he is organising round tables, but I assure her that I am visiting services at the frontline as well. At the core of the point that she has made is the issue of a rights-centred approach for mental health patients, and that too is at the centre of Sir Simon’s inquiry. Patients need to be empowered to ensure that they receive the right treatment. Central to that is the whole issue of consent, which is something that very much concerns me, and not just in the context of mental health. We may be able to take the lessons from Sir Simon Wessely’s review and apply them elsewhere in the NHS.

[James Heappey (Wells) (Con)]

Does the Minister agree that a better laydown of mental health services, involving crisis houses and step-down facilities, might end the need for people to be admitted to acute mental health facilities in the first place, or else support them immediately after their discharge? Will she join me in encouraging the Somerset CCG to ensure that such facilities are available in that county as well?

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

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

I welcome the Government’s outlawing of the use of police cells for those experiencing a mental health crisis, and I do not question the Minister’s commitment to improving the service, but the system is fragmented. There have been local authority cuts, including cuts in community services. The Health and Social Care Act 2012 leaves local commissioners to decide where the money goes, which has led to a confusing local picture and fragmentation. Do we not need to give people clear pathways out of hospital, and to ensure not only that the money goes to the right places, but that individuals know their rights and that local agencies know their responsibilities?

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.

[Giles Watling (Clacton) (Con)]

Does the Minister agree that involving more patients in determining their own care packages and giving them more control over their own treatment is part of the treatment itself?

[Jackie Doyle-Price]

I totally agree. Feeling empowered and in control of one’s own care is quite a big part of the journey towards getting better. We are very concerned that we are still finding cases in which people are being detained under the Mental Health Act without being properly apprised of their rights under the Act, and without the support of advocates to represent them. Dealing with that is very much a priority as we drive improvement forward.

[Alison McGovern (Wirral South) (Lab)]

More than half of women with mental health problems have experienced violence or abuse, so may I ask the Minister what reforms will be made to the support available to women with mental health difficulties, particularly to reflect women’s experience of abuse in coercive or controlling relationships?

[Jackie Doyle-Price]

The hon. Lady raises an issue that is close to my heart. In my opening statement I highlighted the discrimination faced by black people in detention, but I could just as easily highlight the discrimination faced by women. As she says, if they become victims of domestic abuse or coercive relationships, they often face mental health challenges as a result, and they are more likely to be detained in those circumstances. I co-chair the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and towards the end of the year we are looking to bring forward concrete actions to tackle exactly this kind of discrimination and make mental health services more responsive for women.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a doctor, I know how carefully doctors and other health professionals consider individuals before resorting to detention under the Mental Health Act. Does the increase in detentions under the Act reflect a general increase in mental health problems in the population, or can it be better explained by a greater proportion of people becoming so unwell that they need to be detained in order to support their care? What research is the Minister doing to determine which is the better explanation, and to ensure that we identify those people who are going to become severely ill in time to treat them?

[Jackie Doyle-Price]

Clearly, if we can determine the causes of the increase in mental health detention, that will become part of the toolkit that we use to tackle the issue. This is one of the things that we are asking Sir Simon Wessely to look at. There are anecdotal examples of why this might be happening, but the fact that we are seeing higher rates of detention among the black community and among women raises some interesting questions that will bear further examination. I recognise my hon. Friend’s point completely. Good medical practitioners will use detention under the Mental Health Act only as a last resort, and we must ensure that that good practice is spread as far as possible.

[Wera Hobhouse (Bath) (LD)]

An acute mental health facility in my constituency has been forced to close because refurbishment would be too expensive, and patients are forced to travel a long way outside Bath. Is not a local facility much better suited to treating mental health problems than a facility that is many miles away, particularly because carers are a long way away as well?

[Jackie Doyle-Price]

Generally, I would say that local facilities were better, but there is also a tension between a local facility and a good facility. It is better that patients should get the best possible support rather than the closest possible support to them. That is a balancing act, and it is something that needs to be determined by local commissioners.

[Huw Merriman (Bexhill and Battle) (Con)]

It is absolutely essential that every one of us should challenge the system to give more, but could we also talk up progress where it has been made? The Sussex partnership has had a difficult past, but it has gone from being rated as requiring improvement to being rated as good, and one of its categories has been rated as outstanding. Can we praise the staff who are doing things well?

[Jackie Doyle-Price]

We absolutely should do that. I often think that when we are challenging each other in this place about things that are poor, we end up talking our services down, but it remains the case that the NHS is the best health service in the world, and we should always celebrate that fact. Also, the fact that we are putting mental health services under such scrutiny is in itself driving an improvement in performance, because, as we all know, sunlight is the best disinfectant.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Further to that response, the CQC says that it has seen limited or no improvement in the key concerns that it has raised in previous years. The problems are long-standing and they have been raised by the quality regulator in previous reports to Parliament. Does the Minister not understand, when she tries to tell us that sunlight is the best disinfectant, that all we are seeing in our mental health services right now is clouds?

[Jackie Doyle-Price]

I would say to the hon. Lady that this report represents sunlight, not clouds. It is very transparent, and these are exactly the things that I will be holding myself and NHS England to deliver to address these points.

[Helen Whately (Faversham and Mid Kent) (Con)]

It is very worrying to hear the CQC’s judgment that there has been limited or no improvement, especially relating to the failure to involve patients in planning their care. The Government’s review of the Mental Health Act is therefore timely, and it rightly considers evidence from people who have experienced being sectioned. The report mentions significant variation in performance. Will my hon. Friend be looking into the performance of specific organisations? Can we have more transparency about the failures, down to specific organisation level? What steps are being taken to intervene earlier and to care for people better in order to avert crises and reduce the need for sectioning in the first place?

[Jackie Doyle-Price]

My hon. Friend will be aware that, in addition to this annual review of how the Act operates, the CQC is also involved in inspections at individual provider level. Those institutions that are not performing to the standards that we expect are under close scrutiny by the CQC. In fact, I have had exchanges on the Floor of the House about some of them. I repeat my point about the spirit in which we embrace the challenges offered in the report. We have asked the CQC to undertake this annual report precisely so that we can ensure that the Mental Health Act is operating properly, and I actually welcome its frankness. I do not run away from the criticisms in the report, because it highlights exactly where we need to take action.

[Mr Dennis Skinner (Bolsover) (Lab)]

If everything in the garden is lovely for mentally ill people, why am I constantly told by people in my constituency that another Government Department—namely, the Department for Work and Pensions—is getting loads of people who are mentally ill to be reassessed, having been out of work for several years in some cases? If the Government want to help mentally ill people, somebody should tell the DWP to stop sending these mentally sick people for reassessment.

[Jackie Doyle-Price]

The first thing I would say to the hon. Gentleman is that I am not pretending that everything is rosy. One of the reasons we are making this such a priority is precisely because it is not, and we are determined to deliver improvement. He mentions the DWP, but I do not think that we should write people with mental illness off and say that they can never work again. It is in that spirit that we are working with the DWP to look at where we can help people, through person-centred interventions, to get back into work if they are able to do so. That is exactly what we are doing, and I hope that it will become very successful.

[Alex Burghart (Brentwood and Ongar) (Con)]

Obviously, the CQC report will help to inform a lot of ongoing Government work. With that in mind, will the Minister assure the House that Sir Simon Wessely’s review will look at the concerns of people from ethnic minority communities, who have particular issues with detention at the moment?

[Jackie Doyle-Price]

I can give my hon. Friend that assurance. The increased prevalence of people with a black background being detained is very much part of Sir Simon’s review.

[Richard Burden (Birmingham, Northfield) (Lab)]

Is the Minister also aware of the CQC report out today that rates as inadequate the child and adolescent mental health services in the Birmingham Women’s and Children’s NHS Foundation Trust? That is partly because of its vacancy rate of 27%, which the report says has

“impacted directly upon patient care resulting in poor patient handovers, cancellation of appointments, increasing waiting lists, patients waiting allocation of care coordinators, inconsistent care and low staff morale.”

Does not this indicate that, contrary to what she says, mental health services are not getting the resources they need, either in Birmingham or anywhere else?

[Jackie Doyle-Price]

I was not aware of that report, but the hon. Gentleman highlights the positive influence of CQC inspection. He has highlighted a provider for which things are not going so well, and that will enable an intervention to be made through the CQC to improve performance. In the meantime, the local commissioners in Birmingham can buy services from other providers.

[Johnny Mercer (Plymouth, Moor View) (Con)]

My hon. Friend the Minister is right to highlight some of the concerning figures in this report, but there are some encouraging ones too, and does she agree that those who get a mental health problem in the United Kingdom today have a higher chance of being diagnosed, treated and making a recovery than ever before in our history, and that this is largely due to the brilliant staff up and down this country in tackling this fight?

--- Later in debate ---

[Jackie Doyle-Price]

I completely agree with my hon. Friend: they are better than they ever have been, but that does not mean we cannot do better, and we must strive to do better.

[Chris Bryant (Rhondda) (Lab)]

The mind and the brain are intimately associated, and I heard a horrible story this morning of a man who, after having been in and out of prison and in the criminal justice system and in and out of mental health institutions throughout his life, only really discovered at the age of 44 that many of his problems had originated from a traumatic brain injury at the age of 17. If he had been properly treated then, and had the rehabilitation that is unfortunately not available to so many people today, he would not have been through all of this round of problems. So will the Minister make sure that we get proper rehabilitation services for everybody who has a traumatic brain injury?

[Jackie Doyle-Price]

The hon. Gentleman gives a very powerful example, which highlights better than any other we have heard today the challenge we face. Not only was that person failed at the time of having his brain injury, but it was not subsequently picked up as he went through the criminal justice system, and I often say that we can deal with one weak link in a chain of events, but when we have a succession of them, things go horribly wrong. It is very much top of my list to make sure we have better integration of services between health and the criminal justice system, to pick up precisely those situations.

[Tony Lloyd (Rochdale) (Lab)]

The Minister rightly said that police cells are inappropriate places to detain people with mental health breakdown, but she and the Government must address the fact that the police have a duty of care to people in mental health crisis until they can deliver them to qualified mental health professionals. The right facilities are simply not available everywhere, and we must make sure that they are, both for the police and, more importantly, for people in the middle of a health crisis.

[Jackie Doyle-Price]

The hon. Gentleman is absolutely right. We have seen impressive and rapid rates of decline in the detention of patients in police cells, and I congratulate police forces and police and crime commissioners for helping to achieve that, but he is right that we need to make sure that, when people are taken to places of safety, suitable facilities are available for them.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

Yesterday some of us were present when Esther Rantzen told us that calls to Childline from children with suicidal feelings had risen in 10 years from virtually none to over 22,000 last year, and the CQC report yesterday found that young patients are not receiving the mental health care they need. So can the Minister explain why only 7% of the overall mental health budget is spent on children, when children make up 20% of the population and 50% of enduring mental health conditions materialise by the age of 14?

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Lady is right to highlight that point, and that is exactly why we have brought forward the children and young persons Green Paper, recognising that the earlier we intervene, the more likely we are to delay and prevent any long-term mental health issues. We are working with the Department for Education, and we are going to be rolling out 8,000 mental health support staff to work in schools to identify precisely that early intervention. The point the hon. Lady makes about Childline raises more questions about why the number of such calls have increased, and we need to do more to understand that. We know some of the social causes that lead to poor mental health, such as domestic violence and other kinds of trauma; they have been with us for a long time. We also need to look at whether there are other environmental factors contributing to that.

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

I say very plainly to the Minister that nobody on this side of the House is criticising the staff in the mental health services; we very much support them, but we need more of them and they need to be better resourced. Can she explain why we in West Yorkshire are one of only six authorities who have had year-on-year cuts for five years? We have now lost £20.4 million from the service. May I add that many people on the autism spectrum also find that they are in need of mental health services and they feel these cuts particularly?

[Jackie Doyle-Price]

As I have said, we have increased the amount of funding for mental health. That is separate, of course, to the commissioning decisions at local level by local authorities, who also have a role to play in this, as the hon. Gentleman knows. I am very conscious of the needs of people on the autism spectrum. We must give that support, and the things we are doing in terms of improving provision in schools will help identify people who are struggling with that. Planning for the future is great, but we are where we are now, and I join the hon. Gentleman in wholeheartedly congratulating staff up and down the country on their efforts in delivering a good service.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

This CQC report shows that the bad old days of poor mental health care are creeping back: insufficient staff, a doubling of restriction, and a third of patients not involved in their care plan. Why do the Government continue to fail people with mental health conditions, and when do they expect all mental health services to be made safe—the most basic of requirements?

[Jackie Doyle-Price]

I disagree profoundly with the hon. Gentleman. This report shows that patients have increased access to advocates, that more attention is paid to the physical health of people with mental health treatment, and that there is better planning for aftercare and discharge, but we are being honest: we still need to do better, and I expect Members to hold me to the findings highlighted in the report.

Eating Disorders Awareness Week

Jackie Doyle-Price Excerpts

Tuesday 27th February 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I congratulate my hon. Friend the Member for Charnwood (Edward Argar) on initiating an extremely important and timely debate. I commend the sincerity and passion with which he has made his case. He has given me quite a long “to do” list, and I suspect that I shall have to come back to him, given the lateness of the hour.

You and I have attended many Adjournment debates together, Mr Deputy Speaker, and it is nice to see so many fellow Members here.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

In fairness, the hon. Member for Strangford (Jim Shannon) is always here.

[Jackie Doyle-Price]

Indeed, and it is always a pleasure to see the hon. Gentleman in his place.

It illustrates the very real interest colleagues have in this important issue. I am grateful for the opportunity to discuss the work of the Department and NHS England in delivering on our commitment to better support people with eating disorders. As my hon. Friend the Member for Charnwood said, eating disorders are both complex and devastating, and are serious life-threatening conditions with some of the highest mortality rates of any mental health disorder for many of the reasons he outlined: people often become so ill that they and their families do not realise how ingrained the problem is. These conditions can also have severe psychological, physical and social consequences, and they often start, and are prevalent in, young people, which is why early intervention is so crucial.

I will set out what we are doing to support children and young people, but that is not to diminish what my hon. Friend said about adults’ needs, which I will come to later. Having said that early intervention is vital, everyone with an eating disorder must have access to timely treatment. That is why we have set up the first waiting times to improve access to eating disorder services for children and young people, so that by 2020 some 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for routine cases. I am pleased to be able to report to the House that we are making good progress towards that goal. The latest figures published in the mental health “Five Year Forward View” dashboard indicate that the NHS is on track to meet that standard, with almost 77% of all patients starting urgent treatment within one week and 83% of patients starting routine treatment within four weeks. That information is for the third quarter of 2017-18. We are making progress, but we still have to meet that goal. The number of people seeking treatment is rising, so we will need to make sure there is a commensurate increase in the ability for patients to get the care they need, as well as continue with our reduction in waiting times.

It is a testament to the work done by Members and Beat, and to the fact that there is greater general awareness, that more people are seeking treatment. Raising awareness and improving the understanding of eating disorders is important. My hon. Friend referred to community treatment, and it is our view that in-patient treatment should be seen as a last resort, which is why the Government announced in 2014 that we would invest £150 million to expand eating disorder community-based care. We are making good on that promise, and as a result 70 dedicated new or extended community services are now either open or in development. That will mean that at least 3,350 children and young people a year will receive swift, effective eating disorder treatment in the community.

The services are designed to give young people with eating disorders and who self-harm early access to services in their communities with properly trained teams. That reflects the fact that there was a lack of consistency, which needs to be tackled on a concerted basis so that we have fewer out-of-hours placements, recognising that the road to recovery is often quicker when people have access to their immediate family networks.

The services available include access to talking therapies, so that children and young people have a choice of evidence-based therapies, and a treatment plan agreed with their therapist and recorded outcomes, thereby avoiding the need for hospital stays. By improving care in the community, we can improve outcomes and recovery, and reduce rates of relapse or the numbers of young people transferring to adult services, which is another area of risk. We and NHS England want to make sure we have consistency in provision, and are investing in new in-patient care where there is seen to be a lack.

I am pleased that my hon. Friend highlighted the great work of Beat, and it is worth noting that the Secretary of State spoke at the launch of the Beat report and paid tribute to the young people who speak out. The bravery of those young people probably does more to raise awareness of eating disorders than anything any of us can do, despite our best intentions. Beat found that one in three adults in the UK could not name any signs or symptoms of eating disorders, which again shows we have a long way to go in raising awareness.

The Government understand the importance of increasing understanding and raising awareness. I will highlight some of the things we are doing in this area. First, we have published NICE guidelines on managing and treating eating disorders for everyone over the age of eight, including adults, children and young people. That guidance is available for healthcare professionals and commissioners who provide public services to people with eating disorders.

Secondly, we have set out ambitious plans in the children and young people’s mental health Green Paper, partly to address the point made by the hon. Member for Enfield, Southgate (Bambos Charalambous). We are trying to create new mental health teams in schools, perhaps the earliest of early interventions, recognising that the earlier we can intervene, the more likely we are to avoid longer-term damage and crisis and to achieve better outcomes with people who are struggling. Some 8,000 new NHS staff will work closely with those teams in schools to deliver that enhanced support.

As my hon. Friend the Member for Charnwood said, we talk a lot about children but what about the adults? To further improve adult eating disorder care, we have developed a pathway, together with detailed implementation guidance for providers. That is in development by the National Collaborating Centre for Mental Health, in partnership with NICE. It is being fully informed by the available evidence and the views of experts, and will increase healthcare professionals’ awareness of the early signs and symptoms of eating disorders so that they too can refer their patients without delay.

Central to all this is the data collection that is being done by NHS England. My hon. Friend wanted to make sure that the moneys we are making available are actually being spent on the services on the ground, and that all clinical commissioning groups are delivering against their obligations. We are collecting that data. NHSE is undertaking a very close CCG-by-CCG analysis of exactly the pattern of care in each area so that we can make sure that everyone has access to prompt treatment and that we have consistency in access to provision.

Later this week, as it is Eating Disorders Awareness Week, I will be visiting the Bristol eating disorders health integration team—weather permitting, that is. This is a team of psychologists, academics, commissioners, care and support providers, and people with lived experience of eating disorders who are all working together to improve care and quality of life for people with eating disorders in Bristol. The team focuses on both prevention and treatment. If we can find examples of good practice and share them, we will go a long way towards achieving consistency of provision. I very much look forward to meeting those clinicians and experts-by-experience to see what we in Government can do to support them.

Again, I thank my hon. Friend for bringing this debate to the House. I am sure that this is not the last time that he will speak to me about this issue, because it is not the first time he has spoken to me about it either. I thank everyone for participating in the debate. I know that everyone here has a significant interest in mental health and those suffering with eating disorders. We all know that this can be the most fatal of all mental illnesses, and that every death is a tragedy. That is why we are very much committed to doing everything we can to combat this terrible illness.

Question put and agreed to.

Organ Donation (Deemed Consent) Bill

Jackie Doyle-Price Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Madam Deputy Speaker, for giving me the opportunity to speak in this very important debate. I congratulate my hon. Friend the Member for Coventry North West (Mr Robinson) on bringing this Bill forward in the Chamber and on raising our awareness of the issue. I also thank and congratulate my colleague, my hon. Friend the Member for Sunderland Central (Julie Elliott), on her very emotional, personal and courageous contribution to the debate. I am quite confident that the public and Members will have taken note of it.

Others have spoken at length about the importance of raising donation rates. I have my own personal reasons for supporting the move: my younger brother has been waiting for more than five years for somebody, somewhere, to donate a kidney. He has dialysis four times a week. Another very close personal friend is also going through the same difficult times. Therefore, I have those reasons for supporting the Bill, as well as my own personal views, and a moral commitment to the cause.

As many colleagues have said, more than 6,000 people are still actively waiting for a transplant in the UK. Three people die every day because they cannot get the transplant that they need, ruining family lives across the country. Over the past 10 years, the number of donors has increased by 75%, which is fantastic and has saved countless lives, but there is still a great shortage both in the UK and—as we are a global community—internationally as well. If we go to any country, we are asked, “What are you doing in this field?” I am glad that, once again, Britain is leading in this field, so that the rest of the world can learn and pick up its ideas from here.

Only a third of eventual donors are registered to donate at the time of their death, and this number is even lower among the black, Asian and minority ethnic communities. BAME patients fare far worse than other patients. They will, on average, wait six months longer for a transplant than a white patient. I do apologise if my language is not politically correct, but for convenience, I will use black and white in this case. BAME people face the struggle of comparatively rare blood and tissue types and compatible organs. Although the overall number of donors has increased by 75%, BAME donations have only increased by less than 7%—a fraction of the rate for white people—and that has translated directly into deaths.

There is still a problem with public education and awareness. The families of minority populations are also less likely to consent to organ donation when asked after death: 64% of BAME families refuse permission for donation compared with only 43% for the rest of the population. An opt-out system rather than an opt-in system will increase the likelihood that donors of the same blood and tissue types are available to members of the BAME community. Increasing the number of compatible organs on the transplant list could save thousands of lives each year.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the hon. Gentleman for giving way. He is making some extremely important points in his speech, and they are ones that I am particularly conscious of and really want to tackle. Let me amplify some of his points: of the 6,400 people on the waiting list, more than a 1,000 are from Asian backgrounds and 800 are black. I just wish to endorse his point that, in terms of racial fairness, we really need to increase donation from those parts of the community.

[Mr Sharma]

I am glad and thankful for the Minister’s very positive intervention and for the information that she has provided to Members in the Chamber. Activist groups and campaigners, such as the National BAME Transplant Alliance, support the move to an opt-out system, because it will ultimately save more lives across our diverse country.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the hon. Member for Coventry North West (Mr Robinson) for bringing this Bill to the House; he has secured his fortunate position in the ballot and used it constructively. I am therefore grateful to him and confirm that the Government will give his Bill our wholehearted support. It has been an absolute pleasure to work with him and the hon. Member for Barnsley Central (Dan Jarvis) and to get to the place we are in now, having a Bill we can all support. The reason why we are here, in a relatively painless way given our discussions, is that we were all focused on the shared objective of saving lives and securing the availability of more organs for donation. I am extremely grateful to him, and I wish the Bill Godspeed and hope that it gets on to the statute book as soon as possible.

We have heard some moving stories today, and I want to make particular reference to my hon. Friend the Member for North Devon (Peter Heaton-Jones), who talked about the bravery of Keira Ball, who has saved four lives. I shall say a little more about that later. I also want to thank the hon. Member for Sunderland Central (Julie Elliott), who spoke movingly about her daughter. The real thing about this subject is that once we hear the human stories about people who have given organs, consented to their relatives doing so when they have been bereaved, witnessed family members needing an organ or indeed been a live donor, we cannot fail to be touched by their experiences. It is certainly with considerable commitment that I will do my bit to ensure that more organs become available for donation.

[Mark Tami]

I have spoken briefly about my own experience with my son, who was able to get a stem cell donor. We were in hospital for quite some time, and I saw many parents who did not find a donor. That was very difficult, and, to be frank, I felt a degree of guilt because we were fortunate and I knew that I was looking at someone whose child was going to die. That is a heartbreaking situation, and we need to do whatever we can to ensure that more people get on to the register and donate organs.

[Jackie Doyle-Price]

The hon. Gentleman puts that as well as it could possibly be expressed. That is entirely the motivation behind the Bill. We are losing too many people each year because they need organs, and it would be a poor Health Minister who did not do their best to remedy that. He is absolutely right to describe the very real impact when we see people in that situation. I have been on my own journey with my constituent, who has already been mentioned by the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy). My constituent painfully lost her daughter, who was waiting for a transplant, and she has used that experience to campaign for this important cause. She has also taken the step of becoming an altruistic donor herself. Who could fail to be inspired by such a story? I am pleased to be able to deliver on the promise that I made to Patricia, when she came to see me for the first time, that I would do everything I could to secure more organ donations. And here we are today, delivering that.

Last October, the Prime Minister pledged her personal support to change the law on organ donation and, in doing so, to help more people across the country to achieve an organ transplant. We should also remember the contribution of Max Johnson, whose struggle was embraced by the nation and who has done so much to highlight this important cause. As a consequence, we in the Government will be referring to this legislation as Max’s law, and we will do everything we can to ensure its passage. In that regard, I am grateful for the Opposition’s support, which will ensure that it has a speedy passage. With such cross-party commitment, we should not fail. As Max, his family and families all over the country who have experienced life on the transplant waiting list know, organ donation is a precious gift, and the family of Keira Ball deserve our special tribute. The fact that she has saved four lives is incredibly inspirational.

I want to echo the tributes that have been paid to the Daily Mirror. We do not often talk about national newspapers in a complimentary way in this House, but the Daily Mirror has done a fantastic job of highlighting this cause. This illustrates what the press can achieve when it puts its mind to something positive. I echo the tribute paid to “Coronation Street” by the hon. Member for Washington and Sunderland West (Mrs Hodgson). Like her, I am pretty addicted to the soaps, and we should not leave out “EastEnders”, which highlighted live liver transplantation last year. She was right to say that the soap operas have also been good at highlighting mental health, but it is particularly apposite that we have seen the organ donation story this week. I commend “Coronation Street” for tweeting a link to the Government consultation in the immediate wake of that programme, which I think is a first. It would be helpful if soap operas highlighted future Government consultations, but I do not think it will be common.

I will be fairly brief in addressing some of the points that have been raised. A number of Members expressed concern about moving from an opt-in system to an opt-out system, and I reassure them that the concept of organ donation being a gift voluntarily given by the donor remains central to the Bill’s principles. There can be no question of the state taking control of organs, which is why the ability to opt out is central to the Bill. Opting out will have to be made extremely easy, and people will have to be able to continually revisit their decision if they wish to change their mind.

It is also central to the Bill that family consent is respected. The circumstance in which someone is able to donate their organs is clearly traumatic and difficult. In considering the whole period at the end of life and the struggle that surgeons are undertaking to save lives, it is important that we are sensitive about that time. We need to be sure that, once someone has lost the capacity to give consent, their family, as next of kin, have their rights protected. I have no doubt that we will explore some of those issues in Committee.

I put on record the representations I have had from the medical establishment, which would feel uncomfortable if consent were not sought from the family. In developing a regime that secures more organs but is also sensitive to everybody’s views, we are able to strike the right balance in the Bill.

[Tom Pursglove (Corby) (Con)]

I entirely support the Bill. Has the Department given any early thought to public engagement, so that people are aware of any changes coming into force and of what those changes mean?

[Jackie Doyle-Price]

My hon. Friend will be aware that we are consulting on the principles enshrined in this Bill. That consultation will end on 6 March, and we will reflect on those representations. As we have already heard, we are seeing an unprecedented response to the consultation, and there is a substantial degree of support. The consultation will inform our communications.

We have also heard a lot about the high incidence of people from Asian and black backgrounds on the waiting list, and again that is a priority for the Government. The hon. Member for Ealing, Southall (Mr Sharma) said MPs should show leadership. We are leaders, and it is certainly something that I want to do. I have a large black African community in my constituency that I am engaging with on this issue. With that in mind, I have tasked NHS Blood and Transplant to develop MP toolkits that we can all use to go out into the community to sell the concept of organ donation. As and when those toolkits are available, I hope to have support from many Members in rolling out that communication.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

Will the Minister give way?

--- Later in debate ---

[Jackie Doyle-Price]

I would like to make progress, so I will take no more interventions.

As I have made clear, we support the Bill and are determined to secure more organs for transplant, because we are concerned that we are losing lives unnecessarily. People have referred to the experience in Wales and whether the learning from that will achieve a material difference. At this stage, it is too early to draw any conclusions about the number of organs that the change in Wales has secured, but we have seen an increase in consent and opting on to the register. Our best estimates are that the change will secure an additional 100 donors a year, which could lead to the saving of 200 extra lives.

[Layla Moran (Oxford West and Abingdon) (LD)]

Will the Minister give way?

[Jackie Doyle-Price]

I will take no more interventions.

On the basis that we could save 200 lives, we wholeheartedly support the Bill. I look forward to working with all Members to secure Royal Assent.