Health and Social Care

Jackie Doyle-Price Excerpts

Wednesday 12th June 2019 Ministerial Corrections

The following is an extract from the Westminster Hall debate on Medical Aesthetics Industry: Regulation on 14 May 2019.

[Jackie Doyle-Price]

We are moving into a new period of regulation of dermal fillers. My hon. Friend the Member for South Leicestershire is quite right that they are completely unregulated at present, but they will become regulated by the Medicines and Healthcare Products Regulatory Agency, which will put them on a similar footing to Botox and will mean that they need to be given by the prescriber.

[Official Report, 14 May 2019, Vol. 660, c. 88WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price):

An error has been identified in the response I gave to my hon. Friend the Member for South Leicestershire (Alberto Costa).

The correct information should have been:

[Jackie Doyle-Price]

We are moving into a new period of regulation of dermal fillers. My hon. Friend the Member for South Leicestershire is quite right that some are completely unregulated at present, but they will all become regulated by the Medicines and Healthcare Products Regulatory Agency from May 2020.

National Marriage and Mental Health Awareness Weeks

Jackie Doyle-Price Excerpts

Thursday 16th May 2019 Westminster Hall

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

Thank you, Sir David. I am sure you do not want to listen to me until 4.30 pm; in fact, I know very well that you do not. It is a pleasure to be here with you this afternoon.

I have really enjoyed listening to this debate. There have been some compelling arguments on a subject that we do not really discuss very often, yet it is the foundation of our society. This debate is a welcome opportunity to do that. Certainly, listening to all hon. Members’ remarks, I was given considerable food for thought, so I shall do my best to address the points that were made. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing the debate and on having the imagination to bring together National Marriage and Mental Health Awareness Weeks.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about who might have responded to the debate were it not for the reference to mental health, which is an interesting question. Various Departments have an interest, including the Department for Work and Pensions, the Department for Education where the issue affects children, my Department where it impacts on mental health, the Ministry of Justice where it might lead to offending behaviour and the Ministry of Housing, Communities and Local Government in so far as it might lead to addiction.

This all comes back to the state delivery of services and how it tends to rely on a uniform process, yet we are dealing with human beings. If they require support, a one-size-fits-all, tick-box approach will not necessarily be effective in all cases. To be honest, when we see people whose adverse childhood experiences have led them to harm either themselves or others, I view that as a state failure. Perhaps we ought to look at the drivers of child poverty and see whether we can ensure a more effective Government response. When I sit on various cross-departmental working parties looking at domestic violence, mental health or knife crime, I often think they could all be brought together to look more holistically at the children who need early intervention. We need to get much better at that.

Obviously, how we raise our children and family relationships are crucial to how they turn out. We know that for some people, particularly those living in poverty or with an addiction or those who suffer stress, life can be hard. It ought to be available to us to give people extra help. My hon. Friend the Member for Congleton referred to the troubled families programme in her opening remarks. The ethos behind the programme was to support the families that needed extra help. We need to learn from that programme to see what works best so that we can do things better. That is very much in our thinking.

My hon. Friend also talked about some of the initiatives that we are already taking with respect to mental health and highlighted the new mental health teams that we are creating. She suggested that the teams need to work not only in schools but in families. Sir David, you heard me speak about the Charles Dickens primary school in Southwark in another meeting. I visited it as we were developing our thinking on the new support teams, and it had taken a very imaginative approach to embedding mental wellbeing throughout the school and the curriculum. Instead of having teaching assistants in the classroom assisting, the teaching assistants were doing one-to-one interventions with children. As well as one-to-one tuition, some of them were involved in reaching out and building relationships with the parents. Our school network is exactly where we ought to be able to identify the people who need a little more help.

[Fiona Bruce]

I am delighted to hear that. I do not know whether the Minister has heard of a similar approach taken by Middlewich High School in my constituency, but what is excellent about that is that the school is now reporting improved GCSE results because it works not only with the pupil, but with the whole family.

[Jackie Doyle-Price]

As my hon. Friend says, it is not rocket science. If someone is physically, mentally and socially fit, they will have a feeling of wellbeing overall. If any of those pillars falls down, it drags down the rest. If people have a happy environment at home, they will be happier in school and more disciplined and focused. If they live in a dysfunctional environment, they will want to escape, and that will not be good for their GCSEs or anything to do with their long-term development.

[Fiona Bruce]

Will the Minister allow me to intervene again? I do not want to interrupt too many times.

[Jackie Doyle-Price]

We have plenty of time.

[Fiona Bruce]

Yes, so we have heard from Sir David. Corporates are also realising how important this is to the bottom line: productivity. If people arrive at work having left a happier home, they will be more productive, which is an interesting factor to consider if we multiply it across the nation. It is fascinating that we have one of the highest levels of family breakdown in the world, but also low productivity compared with many of our competitor countries. The Minister touches on that when she talks about the flourishing of a human being in terms of relationships and productivity, which are not disconnected.

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

[Barbara Keeley]

One interesting point, which I did not make, from the piece of work that I referred to from yesterday is that placements for children and young people in private units of the type that I talked about are more expensive. They can be £500,000, £600,000 or £700,000 a year, whereas support in the community would doubtless not be as much as that. They would not be 200 miles away from the families, and they would have the support that they need.

[Jackie Doyle-Price]

I agree completely. The reason why we have so many children in out-of-area placements—which, as the hon. Lady says, are expensive—is that there has not been sufficient support in the community. Nor has it been available early enough to give the children support. They have been badly failed. It has done them harm and made them more ill. The issue of out-of-area placements is of massive concern to me. I am making it a personal priority to fix it. I am concerned that, because it is seen as a specialised area of commissioning for NHS England, it commissions a quantum of beds, but that is what leads to them being out of area, and children are referred to them. We all know that their recovery will be much better if they are in their support networks near their friends and families.

When the system works well, it is absolutely inspirational. I visited an intensive care unit in east London last year. A young lady had come out the other side, having gone in for treatment for self-harm and anorexia. She was very clear that being able to undergo treatment while still being able to attend school was crucial to her recovery. To me, that seems compelling. I am deeply unhappy at the extent to which out-of-area placements are still being used. I am afraid there will probably be a need for them until we can be properly confident in our community services to work more effectively, but I am sure we all agree that we need to tackle it as soon as we can.

I enjoyed listening to the observations of the hon. Member for Strangford (Jim Shannon) about what makes a happy marriage. He is right that hard work is a big part of it.

The hon. Gentleman also shared the length of marriage in his family. This year, my parents are celebrating 50 years of marriage. Having lived with them for 21 of those, I have to say that that is quite an achievement. Obviously, it takes real work. As he says, quite often we do not like our partners, but clearly, notwithstanding the difficulties, they give us comfort and security. Not having a support network to rely on, whether that is a partner, wider family or friends, makes life a lot more difficult. I recognise that some relationships will be rollercoasters. Pressures, such as financial debts, can cause untold difficulties in relationships. There will be times when people need support and we need to make it easy for them to ask for it. We have heard several references to organisations that try to give support to couples, such as Relate. A problem shared is a problem halved—we need to encourage more of that.

I was horrified by the story that the hon. Gentleman shared of the couple neither of whom wanted custody of their children. That suggests that they were the product of dysfunctional families, which is another thing to consider. If we leave children to grow up in dysfunctional families, they will repeat that experience. We need to try to do better to improve the quality of family relationships, because that would be good for society. When we look at the back stories of people who end up in prison, we see that there were no end of opportunities where they came into contact with the state, either at school or in other ways. That is a failure for us and we need to tackle it.

It is always a pleasure to listen to my hon. Friend the Member for South West Bedfordshire, who really is a social justice warrior. Again, he brought home clearly the effect of the state applying process to everything and forgetting the humanity of people. We need to be more sensitive about how we intervene supportively. The institutions and the way we organise society can be excessively intimidating and formal, which is not the way to deal with people who need more emotional support. We need to think carefully about what sort of agencies should do that. The beauty of schools, and directing support via schools, is that they are not intimidating or formal institutions. Parents and children have peer support there, over and above their actual attendance, from friends and other people attending and taking their children.

We need to look at the avenues for engagement with people and make sure that they are fit for purpose, and to recognise that all Departments have a role in that. We siloise that contact. Mrs Bloggs takes little Jimmy to school, has a nice relationship and feels that they are being supported, but when she goes to the Department for Work and Pensions, she is treated as an operational performance and it is dehumanising. That is where we need to be more joined-up in the support that we are giving to families. There is a lot to learn. State institutions rely on process to ensure uniformity and fairness, but that does not always lead to good outcomes.

As my hon. Friend said, Governments are expected to do everything, but for the reasons I have outlined they are not always best placed to do that. Sometimes, rather than inventing processes and grand programmes, we should look more actively at letting 1,000 flowers bloom. Where third-sector organisations bring value, we should look at directly commissioning more services from them. That is the case in respect of mental health, because not all support for people suffering mental ill-health is clinical. Quite often, they will benefit from support that just helps them to get through life. That is something that third-sector organisations can do well. I have challenged clinical commissioning groups to look more actively at what they can do, because they will be able to deliver more care by not always relying on clinical staff.

I greatly enjoyed listening to the hon. Member for Glasgow North (Patrick Grady). He is wearing a fetching tartan and I am jealous that we have only the green ribbons. I will think about how we can outdo the Scottish tartan for Mental Health Awareness Week next year. He reminded us that it has been quite a week for mental health and mentioned the axing of “The Jeremy Kyle Show”. The incident that preceded that axing is a wake-up call; it shows that dysfunctional families have become entertainment. What does that say about how we operate as a society? I hope this gives everybody an opportunity for some self-reflection; it is not something that we should use for entertainment.

[Barbara Keeley]

I wanted to refer to what the hon. Member for Glasgow North (Patrick Grady) said about detoxifying issues, which is important. The worst thing that I have read about “The Jeremy Kyle Show” is not that it focused on dysfunctional families, but that it set people against each other in an aggressive way, so it needed bouncers and security staff on hand to part people. The programme seems to have used a toxic formula, which is something that the House could look at through an inquiry, because that could persist in other types of filming. Clearly, it has had a tragic outcome, which, given the Minister’s brief, we have to take seriously.

[Jackie Doyle-Price]

I share that view. By definition, if people are making TV that is designed to be entertaining, it will be manipulative and exploitative. A good friend of mine went on “I’m a Celebrity…Get Me Out of Here!”—not the person who was an hon. Member, but someone else. He told me in great detail about how situations were manipulated to generate conflict. Because he is already a celebrity, he is resilient and well equipped for that, but we can imagine that for people who are not, and for whom being in the public eye is new, the risk of harm is significant. I understand that the Digital, Culture, Media and Sport Committee will be looking at the issue, and I welcome that inquiry. If someone switches on the TV, there will be any number of reality TV shows on—often because, in truth, they are cheap to make. Given their proliferation, perhaps we ought to have some standards that producers should respect.

Another example—this shows how much rubbish I watch on TV—is the axing of “Celebrity Big Brother” earlier this year, or perhaps last year, because of an incident between two celebrities on it. I think the public showed such revulsion because they were celebrities whom the public perceived they knew. If it had been the non-celebrity version and they were two strangers, I doubt that there would have been the same reaction. That tells us that, actually, we have all been manipulated by it. It is only when something terrible happens that we stand back and think, “Hang on a minute, we shouldn’t be doing this.” But here we are.

The hon. Member for Worsley and Eccles South made some very fair criticisms about the challenges to children and young people’s mental health. I agree that one of the reasons that we are where we are is that, historically, child and adolescent mental health services have been far less effective than they ought to have been. I watched the Sky film that the hon. Lady referred to, and I have to say that some of the practices that were referred to in it are utterly unacceptable.

I have been very clear with the CQC that institutions that apply restraint to the extent that the hon. Lady described are totally unacceptable, and it is now being much more aggressive in implementing inspections. We will hold organisations to account. In that respect, the Bill in the name of the hon. Member for Croydon North (Mr Reed) will be a great help. We are in the process of agreeing guidance to deliver that. It will require a real cultural change, but I often say that sunlight is the best disinfectant. The best led institutions are open about when they have to use restraint and fully document it; the worst do not report it at all, and that really has to change. That is something that the CQC challenges now when it visits organisations. I want the number not only out-of-area placements, but of in-patient placements more generally, to come down. That will be a mark of success and a sign that we really are investing in improved community services for our children and young people.

The hon. Lady also referred to the appalling extent to which the young lady in the film had come across people who had engaged in suicide and self-harm. I am pleased that we now have the Zero Suicide Alliance, which is led by the fabulous Joe Rafferty, the chief executive of Mersey Care. Our ambition is to have zero suicides as a consequence of any NHS-funded care. That was launched at the end of last year, and we need to use it as a tool to drive improvements in this area.

As the hon. Lady said, we have the mental health investment standards, whereby we expect local trusts and CCGs to spend more of their budgets on mental health. She suggested that funding should be ring-fenced. I have always felt that ring-fences can be seen as ceilings. However, we are committed, through the long-term plan, to ensuring that all local commissioners abide by those standards, which are a ring-fence in all but name. We are closer than we have been on that issue.

I again remind hon. Members about the troubled families programme, which has been dealing with 400,000 families. It will be revisited next year, and we would welcome any representations from hon. Members about how we can learn from it and improve how we help families with complex needs. Obviously, we need to develop better outcomes for all family members.

Coming back to Marriage Week, we know that good quality relationships are critical for all of us, as they add to our overall happiness. As my hon. Friend the Member for South West Bedfordshire said, some people do not necessarily want their relationship to be recognised as a marriage. None the less, we all benefit from stable, loving and supportive relationships. With my suicide prevention hat on, I will say that relationship breakdown is the biggest driver of suicide. That is another reason why we should always enable people to find help when they need it.

As far as the impact on children and their life chances is concerned, we know that by the age of five, almost half of children in low-income households have seen their families break apart, compared with only 16% of children in higher-income households. As my hon. Friend said, we must address that social injustice because when relationships break down, there is a risk of poor outcomes in the long run.

I see health visitors as very important partners—I always refer to them as my army. They are on the frontline, and their contact with people is less formalised. They are the one group of people who can engage with the entirety of the family. They look not just at the baby and mum, but at dad and the siblings, too. We need to take advantage of those interventions to do better for families in general.

We are spending £39 million on the reducing parental conflict programme, which is designed to reduce conflict between parents who are still together, and work with them to strengthen their relationship, exactly as my hon. Friend the Member for Congleton wants, to help them to stay together if that is what they want. We should also recognise that separation can sometimes be the best option, particularly if there are other factors involved that can cause distress for the children. Even in the event of a separation, continued co-operation and communication between parents and their children will give advantage to the child.

Although the Government will continue to support and champion marriage, we will not discriminate against other types of families who require our support. We will ensure that parents can access help when they need it, whether they are already married and need help to sustain their partnership, are not married and wish to improve the health of their relationship, or have chosen to separate.

I turn to what we are delivering through the NHS long-term plan. The improvement in perinatal mental health services will help us to engage people when they are at risk, assess people’s circumstances, give peer support and perhaps just make a decisive intervention at a time of real stress for families, where either the mother or the father becomes ill.

The theme of this year’s Mental Health Awareness Week is not marriage but body image. The two are not entirely unconnected, because how we think and feel about our bodies obviously affects how we engage with other people. Just as we need to get real and think about working harder, not everything will be ideal. We are not all going to have a marriage that is like a fairy tale 100% of the time, and we are not all going to look like Claudia Schiffer. That is okay—that is normal—and we just need to be aware of that.

It is worrying that, according to the Mental Health Foundation, 39% of children feel shame in relation to body image. We ought to think about the causes of that stark statistic. People are bombarded with images via social media, and so on, so we need to encourage parents to spend time with their children and make sure that children know what they can realistically expect. They cannot expect to look like the doctored images that they are being shown.

That comes back to the issue of quality time. Smartphones have been absolutely revolutionary for our society. Is it not fantastic that we can find information about anything we want and contact people at any time? However, face-to-face engagement, especially between parents and their kids, is really important. I pay tribute to Frankie & Benny’s, the restaurant chain, which has said that to encourage parents to speak to their children while they are having a meal, it will give them a discount if they hand their phone over.

We are so easily distracted by time spent on a phone. The first thing I do in the morning when I wake up, and the last thing I do at night, is to look at my phone. It is not very healthy, to be honest. We need to encourage our children to have a healthy relationship with their smartphones, and the same is true for ourselves. There is no substitute for some good parent-child conversation, and that does not need to take place via WhatsApp or text.

Broader mental health support is available to people who suffer from mental health problems. IAPT provides couples therapy for depression, which is available through the NHS. That directly helps relationships.

This debate has been interesting and thought provoking, and it has highlighted many issues that, although we may agree about them, we perhaps need to be more proactive about properly addressing. They are not the easiest things to deal with, because they are about human failings, but it is good to hear that so many colleagues are bothered about them and actively think about them.

Mental health problems can affect anyone, any day of the year. Those problems have a bearing not only on the wellbeing of the individual, but on marriages, relationships and children. We must continue to work together, across Government and with our partners, to address some of those issues. As a society, we all need to be more sensitive about the stresses of particular times, such as when people experience job loss, debt or relationship breakdown, to ensure that we give people appropriate support.

I am sure we can all agree that Marriage Week and Mental Health Awareness Week provide us with excellent opportunities to bring those subjects together. I am very grateful to my hon. Friend the Member for Congleton for bringing those subjects forward for debate.

Alexandra Hospital, Redditch

Jackie Doyle-Price Excerpts

Wednesday 15th May 2019 Commons Chamber

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

I really thank my hon. Friend the Member for Redditch (Rachel Maclean) for the passionate, articulate pitch she made on behalf of her constituents and the health services that they deserve, because obviously we all deserve good-quality health services. As the Minister responsible, it is my job to give challenge to ensure that we are delivering the best services we can. Obviously, they are not always as good as we would like them to be, but I can reassure my hon. Friend of my determination to make sure that we continue with the constant campaign for improvements, and for the best possible services. All our constituents, as taxpayers, are paying for those services, and they all deserve an equivalent service.

I thank my other hon. Friends from Worcestershire—my hon. Friends the Members for Wyre Forest (Mark Garnier) and for Mid Worcestershire (Nigel Huddleston)—for showing their support. The issues that my hon. Friend the Member for Redditch raises are clearly of concern across the wider area. Indeed, my right hon. Friend the Member for Bromsgrove (Sajid Javid) has also lobbied me about this, notwithstanding the wider interests that he has in this place.

My hon. Friend the Member for Redditch raised several important points and areas of concern, which I will seek to address. She raised a number of points about maternity services. She is absolutely right that we must ensure that we have the safest possible environment in which people have their children. Obviously, having safer births is very much a national priority, so that issue is of particular concern to me. As my hon. Friend is aware, the decision to move maternity and children’s services from the Princess Alexandra Hospital to the Worcestershire Royal was implemented in 2017, and it was clearly controversial—many changes are, and this is no exception. That is why we need to continue to give appropriate scrutiny—my hon. Friend is absolutely right to do that—to ensure that we are serving all our constituents as well as we possibly can. She is also right to say that challenges remain. The trust continues to be scrutinised closely by the Care Quality Commission and in this House.

My hon. Friend asks how long we have to wait. Quite often, changes can be achieved very quickly. Sometimes, however, whether cultural or behavioural changes, they take much longer than any of us are happy with. I say to her that in my experience, constant scrutiny by the CQC does deliver results. I encourage her to continue her discussions with local interest groups and the CQC to ensure that all the constant scrutiny and challenge drives improvement. I do not know how many times I have said it in this place, but sunlight is the best disinfectant. Accountability will drive improvement and change.

All that said, we should recognise that there has been some important progress in the service at the trust. The CQC looked at the maternity in-patient survey for February 2017, which found that the Worcestershire Royal rated well against other maternity services in all aspects of care and scored among the best in the country in partner engagement and involvement in the appropriate length of stay in hospital. In addition, following the reconfiguration of services the neonatal rota is now fully staffed and recruitment is going in the right direction; the maternity doctors’ rota is fully staffed; and the trust has avoided a lot of the cancellation of antenatal or gynaecology clinics that was previously seen. I know that people will be concerned because of the historical record, but the scrutiny of the CQC shows that there are improvements.

According to the most recent CQC report, maternity and gynaecology services at the Alex are rated “good” for caring and “responsive” and “requires improvement” for other domains. Worcestershire Royal is rated “requires improvement” for safety and “good” in all other categories. The CQC recognised that the Worcestershire Royal’s maternity service was especially caring and responsive to parents who had suffered a pregnancy loss, such as miscarriage, stillbirth or neonatal death, and was committed to continually improving the care and services it provided for bereaved parents. That shows that there are some areas where the leadership are making an impact, but we clearly need to keep the situation under review.

In October 2018, the trust’s professional development team won the workforce team of the year award at the prestigious Nursing Times awards, which celebrate excellence in supporting the nursing and midwifery workforce. We congratulate them on that award. We should not be complacent, however. There is still very much more to do. I look forward to further discussions with my hon. Friend in the light of further investigations. We will do our best to support the entire community by making sure that performance is improved.

My hon. Friend raised the wider challenges facing the trust. It has been in special measures since December 2015. The latest CQC inspection judged the hospital as inadequate, with key concerns in urgent and emergency care, surgery and outpatients. I say again that scrutiny is the first catalyst to achieving improvement. It is worth noting that the trust achieved a “good” rating for the caring inspection domain in the latest CQC report, so in terms of patient experience there is clearly some improvement. However, nobody should be complacent about the scale of the task. As she says, her constituents really should not be expected to wait an undue length of time to achieve the quality of service that patients in other parts of the country receive.

I assure my hon. Friend that both the Government and national NHS bodies are committed to providing both the support and investment needed to help the trust make progress. I will be ensuring that we use our levers at a national level to give that appropriate challenge and support. Support currently in place for the trust includes a support package focusing on culture, risk and governance. That is very important. We always find, when a trust is going through the journey from requiring improvement to good, that leadership is crucial. I cannot overstate the importance of making sure that we are getting the right leaders in and mentoring them to deliver that. That support is crucial.

There is a quality improvement director, and there is a nurse retention collaborative programme to reduce turnover. There is a suggestion that that is starting to bear fruit. There will be emergency care support from the emergency care intensive support team and a peer support buddying arrangement with the Royal Wolverhampton NHS Trust. We have seen such buddying arrangements achieve real change, more than anything else by giving local leaders the confidence to be innovative and imaginative and really give additional challenge.

Local commissioners are closely involved in working with the trust to ensure that the quality of children’s and maternity services improves. Given the concerns my hon. Friend has expressed, I encourage her to engage with local commissioners to discuss how they are interpreting reviews of monthly divisional data and what they are doing to assure themselves of the quality of service. As a Minister, I can stand at the Dispatch Box and make promises, but ultimately I rely on local commissioners to do their bit to give challenge too. In giving me challenge, I encourage her also to give them challenge and have those discussions. The spirit of co-operation across the whole system is there to achieve improvements.

My hon. Friend rightly made her pitch for her constituents’ share of the increased funding for the NHS. While improvement is about more than just money, investment is clearly part of the picture. We will make the appropriate investments to support the trust. Recent examples of investments we have made are an award of £3.96 million for a breast imaging improvement plan, which will improve breast screening at the Alex; the development of a maternity hub to serve the Redditch area; and £3 million for a link bridge between the main hospital building and an outer building to be in place for the winter to assist with winter pressures.

I am confident that this will not be the last discussion my hon. Friend and I have about her local health services. I am grateful to her for bringing her concerns to me and putting them on the record. As I say, sunlight is the best disinfectant when it comes to inspection and challenge on the ground, but the opportunity to raise things here on the Floor of the House gives a signal to the entire health system that where we think things are not good enough and need to improve, we will not be shy in our determination to achieve that improvement.

[Rachel Maclean]

I thank the Minister for her comments and share her view that sunlight is a great disinfectant. May I press her? We have been undergoing this journey for four years, which is a long time. I had not been a Member of Parliament before and have never seen a trust turn around, so I would be grateful for some indication of how long she thinks it is reasonable for us to wait, with me as the local MP explaining to people, “You have to keep waiting.” Has she any examples of how it can happen and at what pace?

[Jackie Doyle-Price]

I will answer my hon. Friend’s question, but I will answer a different one too. She asks how long it is reasonable to wait. It is not reasonable to have to wait at all, because we should be delivering services of an appropriate quality. How long will people have to wait? We should be entirely honest when an institution requires improvement. She is right that four years seems like a long time. When my local trust went into special measures, it came out within two years, and the crucial ingredient was getting the right leader in at the top. Other trusts wait longer because other challenges can come into play that mean they are judged to require improvement—some trusts still struggle to get the right personnel, for example. We need to look in detail at exactly where the weaknesses are. My challenge to the system is to come up with a good plan to help get out of it. I would expect the buddying system with the Wolverhampton trust to start to deliver that more effectively, because there is no better driver of speed than external challenge.

With that in mind, I would like to close this excellent debate. The points made here should be considered very seriously by the local health system.

Question put and agreed to.

Medical Aesthetics Industry: Regulation

Jackie Doyle-Price Excerpts

Tuesday 14th May 2019 Westminster Hall

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

It is a pleasure to be here this afternoon during Mental Health Awareness Week, for which the theme is body image, so it is particularly appropriate that we are discussing this issue again, thanks to my hon. Friend the Member for—I can never remember.

[Alberto Costa]

South Leicestershire.

[Jackie Doyle-Price]

Thanks very much—my hon. Friend the Member for South Leicestershire (Alberto Costa). I am pleased that the all-party parliamentary group has been established since we last debated the issue in this place, and I thank the hon. Member for Swansea West—

[Carolyn Harris (Swansea East) (Lab)]

East.

[Jackie Doyle-Price]

I thank the hon. Members for Swansea East (Carolyn Harris)—I never know my east from my west—and for Bradford South (Judith Cummins) for joining that group. It is great to have the hon. Member for Falkirk (John Mc Nally) here, who obviously takes a keen interest in these matters.

[Carolyn Harris]

I apologise, Mr Owen; I tried to get here earlier. May I first congratulate the Department on today’s announcement? Our all-party parliamentary group’s inquiry is the first to assess the current regulation of non-surgical cosmetic procedures and its adequacy in ensuring customer safety. I offer the Minister the opportunity to come and to talk to us and hear the inquiry’s findings.

[Jackie Doyle-Price]

I accept that invitation most gratefully, and I look forward to hearing the conclusions. The time is right for us to take action on this, and I am grateful for the support of Members from across the House in wanting to do that and to do the right thing, with the intention of protecting consumers, which is obviously central to us, but also ensuring a system of regulation that is proportionate for the industry. We need to make sure that we balance both of those.

We have not really given the industry enough attention, given the speed with which it has grown. We increasingly see examples of consumers receiving poor treatment; my hon. Friend the Member for South Leicestershire referred to his constituent, to whom I am grateful for sharing her story. We need to make everyone much more aware of the risk because, as he says, people think it is just like having a haircut; it is becoming extremely normal to have what are poisons injected into the face. We need to make sure that everyone is aware of the risk before they undertake such a procedure, so that they can make an informed judgment.

[John Mc Nally]

I am not taking exception to the idea of it being just like having a haircut, but I have been involved in the business of hair salons for more than 50 years and have run salons, and it is not just like having a haircut. There is a similarity in terms of the investment put into any business, which is long term in some cases. When somebody comes along who has not properly trained and has little knowledge, there will be consequences of what they practise. In my all-party parliamentary group’s inquiries, we have come across modern-day slavery, trafficking, money laundering and all sorts of things, which just builds the case for a mandatory regulatory framework.

[Jackie Doyle-Price]

The hon. Gentleman makes a good point, because when we talk about these examples, there is a danger that people can apply that prejudice to the entire industry. It is in the interests of everyone involved in this industry to welcome regulation, not least to celebrate the professionalism of what they do. There are some very reputable practitioners out there who are not actually in the medical industry. For example, semi-permanent make-up—a surgical procedure that does not involve any invasion—clearly does not require as strident regulation as what we are talking about with injectables, but it is the same industry, and we need to ensure an adequate registration system.

[Judith Cummins]

I very much welcome the Minister’s announcement today. On training and regulation for beauticians—non-medical people who constitute around 50,000 jobs in the UK economy—there is huge appetite and support within the industry for proper and appropriate regulation, and there is recognition of the urgent need for that. However, there are no regulated qualifications available for non-medical practitioners for injectables at the moment. Going forward, does the Minister think there will be some kind of progression route for beauticians to go into this kind of industry, so that we can guarantee proper standards for the consumer?

[Jackie Doyle-Price]

The hon. Lady is right, and I am grateful for the spirit in which she makes her comments. Anyone who establishes themselves in business as a beautician wants to deliver a good service, has pride in what they do and would not want to be accused of doing anything unsafe.

My first focus of activity is those organisations that train people in these procedures, because I can see a situation in which a beautician will have paid thousands of pounds to go on a course and will then think that they are qualified, but they might not be. That is where we need to bring the focus of regulation in the first instance, so that when somebody proudly displays their certificates, consumers can have some guarantee that they are legitimate. I welcome the opportunity to air these issues with the all-party parliamentary group as we move this system of regulation forward.

Sadly, we only have 30 minutes for this debate, so I doubt whether I will be able to get through as much as I would wish, but I will do my best. I am grateful for the interest of all Members here. We will continue this discussion. It is worth saying that Botox treatments and dermal fillers are increasing and, along with laser hair removal, now represent nine out of 10 non-surgical treatments performed in the UK. This is a major area of risk.

Hon. Members have referenced the campaign that we launched today. Clearly, consumers will be the best defenders of their own interest, but we must make sure that they have access to appropriate information with which to do so; we need to do much more to inform people about the risk. Just as in my hon. Friend the Member for South Leicestershire’s example of his constituent, I am quite sure that many people who have had fillers—who have gone to have their lips done, like they do—would have no idea that there is a risk of their artery being injected with poison. We need to make sure that consumers are much more aware of that, which is why we are doing so much more in the next six weeks to try to raise public awareness.

We will focus on targeting our messages to women aged 18 to 34, on whom the majority of the treatments are undertaken. I am pleased that we are working with Bauer Media, which publishes Grazia, Closer and Heat, which I hope will be appropriate vehicles to reach that audience. We will make sure that the NHS information is kept up to date and remains a meaningful resource for consumers.

[Jim Shannon]

Would the Minister consider making it so that under-18s could not have this treatment?

[Albert Owen (in the Chair)]

Minister, you have less than two minutes.

[Jackie Doyle-Price]

Yes, absolutely. I am committed to bringing forward legislation to do that at the earliest possible opportunity. I would really like to engage with the all-party parliamentary group to see what other conclusions they can bring forward quickly, so that we can make use of that legislation, to strengthen the opportunities to have a meaningful register, and indeed to look at the whole issue of insurance and what we should expect everyone involved in this to do.

I am open to debate, and I am absolutely committed to bringing the age restriction in line with things like tattoos and sunbeds. Frankly, it is ridiculous that there is an age limit for getting on a sunbed but anybody can have poison injected into their face. That is clearly ridiculous, and we need to tackle it.

We will encourage consumers to look at choosing a reputable practitioner and to properly interrogate the person doing the procedure, asking them about the risks. I am pleased that Superdrug, which has moved into this field, is having pre-screening conversations with clients and giving them cooling-off time before embarking on the treatment. I think that is really good practice and is something we could encourage throughout the industry, not least because it encourages practitioners to think about how they engage with their consumers and to properly understand the risks themselves.

We are moving into a new period of regulation of dermal fillers. My hon. Friend the Member for South Leicestershire is quite right that they are completely unregulated at present, but they will become regulated by the Medicines and Healthcare Products Regulatory Agency,[Official Report, 12 June 2019, Vol. 661, c. 5MC.] which will put them on a similar footing to Botox and will mean that they need to be given by the prescriber. He is right to highlight the risk of people being able to delegate that responsibility for prescribing, and again we should look at legislating on that. Clearly we could also ask the regulators of medics to look at that, because, frankly, delegating the responsibility for prescribing does not really seem consistent with patient safety. We need to look at that.

I am fast running out of seconds, so I will conclude by thanking my hon. Friend and all hon. Members for their interest in this subject. I hope that we all continue talking about this, so that we can take action quickly. This is massive area of risk for consumers and we need to take action to fix it.

[Albert Owen (in the Chair)]

I am grateful to both the hon. Member for South Leicestershire (Alberto Costa) and the Minister for taking so many interventions.

Question put and agreed to.

Pre-eclampsia

Jackie Doyle-Price Excerpts

Thursday 9th May 2019 Westminster Hall

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

It is a pleasure to see you here again, Mr Hollobone. It is an absolute privilege to respond to the debate brought by the hon. Member for North Ayrshire and Arran (Patricia Gibson). I thank her for bringing it forward, and for her courage and honesty in the way she has approached the subject, which is clearly sensitive for her. Parliament is at its best when it hears people’s direct experience, so I am grateful for the way in which the hon. Lady has approached this.

I do not think the number of Members here reflects the importance of the subject, but, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, the quality of the contributions we have heard, all of which have been linked to direct experience one way or another, has made it one of the most powerful debates we have had in this Chamber none the less. I thank the hon. Member for North Ayrshire and Arran again.

This is the first time that the subject has been debated by Members of Parliament; while that should be shocking, in some respects it is not, because often things that affect many women are not adequately debated in this place. Thankfully, now there are more of us here, we can start to address that, and we will do so all the more often.

The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) talked about his wife’s experience, how she knew her body and presented at the hospital, but was told to go home. I am afraid that happens far too much to women. We often feel diminished or that our voices are not heard. My challenge, in which I am sure all hon. Members will join me, is to ensure that all our health services just stop doing that to women, because it is not good enough. It has left us feeling diminished and not getting the treatment that we all deserve, so I thank him for amplifying that point.

It is always a pleasure to hear from the hon. Member for Glasgow East (David Linden), who has a unique ability to bring to life a dad’s perspective on these concerns and worries. As ever, it was a pleasure to hear from the hon. Member for Washington and Sunderland West, who has also brought her own experience on these subjects in the past. I pay tribute to the work of the all-party parliamentary group that both she and the hon. Member for North Ayrshire and Arran are so passionate about and so active in.

In its short time, the all-party parliamentary group has been incredibly influential; I would struggle to find a more effective one. It is a pleasure for me to work with it and support its work, and I am expecting both hon. Ladies to come with their cap in hand for the next wave of things they want me to fund under that work. It is making a difference and giving support to families on something that has hitherto been taboo, so I am grateful to them for that.

What is important about this debate and about pre-eclampsia is that, as we have heard repeatedly, it is an avoidable illness in the sense that we know the risk factors. To be frank, there is no excuse for the incidence of pre-eclampsia in 21st-century Britain. We may have better performance than other countries—and so we should, because we are Great Britain—but we need to do better, to improve outcomes both for babies, and for mothers and fathers. I rise to the challenge here and will hope to answer some of the requests made in the course of this debate.

It is still the case that pre-eclampsia and HELLP syndrome are a leading cause of maternal mortality and pre-term births, claiming the lives of nearly 76,000 mothers and 500,000 babies internationally each year. However, we know we can monitor the health of people in pregnancy, and we know the healthiest pregnancies are those that are planned, so it is important that we ensure that our policies encourage people to properly plan their pregnancies so that they can manage their health and, in particular, tackle things such as high body mass index and any other risk factors they may have.

In the UK, mild pre-eclampsia affects about 6% of pregnancies, and severe cases develop in about 2% of pregnancies. That is still quite high—dangerously high, considering the risk. According to the statistics for England, 14,352 pregnancies were coded for pre-eclampsia in 2017-18, which is 2.29% of all deliveries. That is 39 women in England diagnosed with pre-eclampsia every day. When we look at those types of figures, they bring home the fact that this condition is more common than the parliamentary attention given to it would suggest.

The prevalence of pre-eclampsia by maternal age or ethnic group is comparable to all pregnancies, but we know there is a risk of hypertensive disorders in women over 40, and those with a gap of 10 years since their last baby are at a higher risk. It is relatively easy to identify the at-risk group. The hon. Member for North Ayrshire and Arran mentioned that there is a higher prevalence among black women, who are five times more likely to die in pregnancy than white women, while Asian women are twice as likely to die. We must ensure that we tackle that, and we will take it forward through the race disparity audit, not least because there are generally other issues that lead to black and Asian women facing higher risk factors in pregnancy across the board.

I have been asked to see that the NHS adopts a life-course focus, rather than a pregnancy disease focus, when looking at this subject. That has come up in my discussions about women’s health. The president of the Royal College of Obstetricians and Gynaecologists tells me that the factors that might lead to a woman’s mortality tend to surface during pregnancy, so it seems to me that we are not taking full advantage of pregnancy to have a look at women’s health and risk factors and help them with long-term prevention of poor health. We really need to do better at that.

For example, there are indications that someone will suffer from chronic kidney disease or cardiovascular disease in later life. We must embrace that life-course approach to women’s health. That is one of the things my women’s health taskforce will take forward, to make sure that we are really not wasting the opportunity of pregnancy to look at the health of women.

Reference has been made to placental growth factor testing, which is being made available in England through the Accelerated Access Collaborative. The hon. Member for Washington and Sunderland West challenged me, fairly, to ensure that trusts make use of that test. We need to take every opportunity to give a nudge and properly encourage all trusts to assess the risk factors in deciding whether to apply those tests.

Obviously, we will continue to have conversations with the Government in Scotland about our experiences. We would also be more than happy to support the efforts of Action on Pre-Eclampsia to raise awareness of pre-eclampsia and other hypertensive diseases in pregnancy during World Pre-Eclampsia Day.

I am pleased to report that there has been a significant decrease in maternal mortality from hypertensive disorders during pregnancy in recent years, but we cannot afford to be complacent. It is certainly true that when we look back at cases where mothers have died, too often, improvements in care could have made for a very different outcome. That reinforces the need to make sure that people are aware of this disease, which can be a killer.

I have been asked to prioritise research into stillbirths from pre-eclampsia. It was such research that supported the study that showed that placental growth factor tests can diagnose pre-eclampsia more accurately than current techniques. We are also funding the PHOENIX study at King’s College London, which aims to determine whether delivery in women with pre-eclampsia between 34 and 36 weeks of gestation reduces maternal complications without short and long-term detriment to the infant, compared with delivery at 37 weeks. That study will conclude next year. We are increasing resources to support parents through the trauma of stillbirth; we continue to fund Sands to work with other baby loss charities and the royal colleges to produce the national bereavement care pathway and to reduce the variation in quality of bereavement care provided by the NHS.

We know that 1,000 babies die every year in the UK because of pre-eclampsia. Most die as a consequence of premature delivery, rather than the disease itself, because the only cure—if, as the hon. Member for North Ayrshire and Arran says, we can call it that—is to deliver the baby. In terms of reducing those deaths, we need to ensure that we are managing that risk. Clearly, it is very important that we take full advantage of all antenatal appointments to do that, so that a pregnancy can be safely managed. We expect midwives to screen for pre-eclampsia at every appointment, by checking the woman’s blood pressure and urine. It is disappointing that MBRRACE-UK found that those routine antenatal checks were not undertaken on most women who died of pre-eclampsia. Straight away, that is something that we really need to give the system a nudge on, to make sure that risks are not taken with the health of the mother or her baby.

On some of the other things that will help to manage this, as part of the long-term plan we will continue to work with midwives, mothers and families to implement continuity of carer, so that there is a longer-term relationship between the mother and health practitioners, who can then have trust and honest, empowered conversations. Women can often feel intimidated when dealing with practitioners who perhaps treat them in a less than humane way. When we have that personal relationship, we can have honest conversations, leading to better care and trust between the mother and her midwife, nurse or doctor.

Pre-eclampsia is very unpredictable, which makes it difficult to manage if the risk factors that add to prevalence are not there. It is clearly crucial that, if a woman’s condition deteriorates, a plan must be implemented quickly, with a multi-disciplinary approach to decision-making recommended. We expect every trust with a maternity and neonatal service to be part of the national maternal and neonatal health safety collaborative, which is driving forward practical improvements to make care safer in all maternity units by the end of 2019-20. I will make sure that there is specific action on monitoring that. NHS England is also supporting the establishment of maternal medicine networks, which will ensure that women with acute and chronic medical problems, including hypertension, have timely access to specialist advice at all stages of pregnancy, which, again, will help those discussions.

Members will be aware that, in November 2017, the Department extended the national maternity safety ambition to include reducing the national rate of pre-term births from 8% to 6%. The new Saving Babies’ Lives care bundle includes a focus on preventing pre-term birth, looking in particular at prediction, prevention and better preparation where pre-term birth is unavoidable. Every maternity service in the NHS is actively implementing elements of the Saving Babies’ Lives care bundle, and we are fully committed to implementing the recently launched version 2 of the bundle by March next year. Adherence to the care bundle is included in the planning guidance and incorporated into NHS standard contracts for 2019-20.

Placental growth-based blood tests clearly provide the ability to better diagnose pre-eclampsia and to manage risks. The tests have been selected as rapid uptake products by the Accelerated Access Collaborative, which works with commercial companies and clinical experts to make such products available much more widely. We will monitor that roll-out. That is an example of how we are trying to be much more fleet of foot when we identify these tests, products or medicines that can make a difference, which involves close working between NHS England and providers to deliver them. As set out in the long-term plan, the NHS will in the future introduce a new funding mandate for health tech products assessed as cost-saving by NICE. Clearly, preventive and testing measures are crucial to that.

I hope that Members welcome the progress made so far on this important issue. I am always happy to hear representations on where we can do better. Clearly, trying to make this country the safest place to have a baby, to make sure that we are doing everything we can to tackle stillbirths and to ensure that all women have safe and healthy pregnancies that deliver safe and healthy babies are priorities of the Government. I am very grateful for the constructive contributions of all Members. I am sure that this will not be the last time that we discuss this subject, even though it might be the first.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 7th May 2019 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

1. What steps his Department is taking to ensure that patients with no (a) fixed address and (b) proof of identity can register at GP surgeries.

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

We are very clear that GP surgeries cannot refuse to register somebody who is of no fixed abode or has no proof of identification. Where a practice does not properly provide correct access to vulnerable groups, the commissioner will intervene to ensure that it corrects that. Ultimately, the commissioner can issue a remedial notice and can terminate a contract or practice that still does not abide by its obligations.

[Kate Green]

Has the Minister seen the report by a mystery shopper from Friends, Families and Travellers who attempted to register with 50 GP practices without ID or proof of address? Twenty-four refused to register her or would not register her; all but two of those were rated outstanding by the Care Quality Commission. The Minister says GPs must properly follow the guidance, but does she agree that the CQC needs to ensure that it uses the inspection regime to enforce that guidance?

[Jackie Doyle-Price]

I totally agree. I have seen the report, which I welcome; I will certainly take it up with the CQC. It is very important that we use all tools to ensure that everyone has access to the healthcare they deserve, because it is all too easy for some groups to remain discriminated against. I am grateful to the hon. Lady for shining a light on this important issue.

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

We have one of the very few free at point of need health services in the world. Does the Minister agree, however, that checks are important in cracking down on health tourism? Does she have the latest assessment of the cost of health tourism to our NHS?

[Jackie Doyle-Price]

My hon. Friend is absolutely right—health tourism is a major cost to the taxpayer, so it is important that we establish that people are entitled to care. However, it is important to ensure that people without proof of ID and of residence are still entitled to healthcare. Where someone is not entitled to it, we will, of course, pursue them for payment.

[Grahame Morris (Easington) (Lab)]

2. What funding his Department plans to allocate to radiotherapy services in the next five years.

--- Later in debate ---

[Daniel Zeichner (Cambridge) (Lab)]

4. What discussions he has had with the Secretary of State for Education on the provision of NHS mental health services for university and college students.

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

The Secretary of State for Health and Social Care met the Secretary of State for Education in February to discuss concerns about mental health and the prevalence of self-harm among young people. “The NHS Long Term Plan” states that we will

“extend current service models to create a comprehensive offer for 0-25 year olds”,

and I expect to have regular dialogue with our counterparts in the Department for Education to make that a reality.

[Daniel Zeichner (Cambridge) (Lab)]

The all-party parliamentary university group has heard consistent evidence about the rising number of students presenting with mental health problems. We have been told that it has increased sixfold in the last 10 years, from 9,675 to 57,000. That poses huge challenges to what used to be counselling services but are now becoming a mainstream part of health provision, funded by universities. What are the Government going to do about it?

[Jackie Doyle-Price]

Young people often fall out of care when they leave their home addresses to go to university. To deal with that transition, we extended the service to nought to 25-year-olds through the forward plan rather than cutting it off at adulthood. That will ensure that we can do more to achieve continuity of care.

I pay tribute to the efforts that universities have made. They have seized on the challenge posed by the increasing prevalence of mental health problems, and I will continue my dialogue with them.

[Vicky Ford (Chelmsford) (Con)]

The students union at Anglia Ruskin University—which is based in Chelmsford as well as in that other “C” place, Cambridge—carried out a big study on student mental health. One of its requests was for students to be able to register with two GPs, one at home and one at university, so that they would not be stuck without a GP in the holidays or in term time. Can we look at that again?

[Jackie Doyle-Price]

I will definitely look at it. As I have said, the transition poses real challenges, because of a process failure rather than any lack of willingness or commitment on anyone’s part. We must ensure that people retain access to services as they move around.

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

The all-party parliamentary group on psychology, which I chair, heard just last week that young people who have done extremely well with child and adolescent mental health services are being put on waiting lists when they move away from home to colleges and universities, and are having to start again from the beginning. They are falling through the gaps. Will the Minister ensure that that does not happen any more, that there is no longer a postcode lottery, and that people who have done extremely well in getting into university receive all the support they need?

[Jackie Doyle-Price]

I see that there is a meeting of minds. Not only do I agree with what the hon. Lady has said, but I have met the hon. Member for Dewsbury (Paula Sherriff) to discuss exactly that issue. There is clearly a systemic weakness in respect of those who move between home and university, and we will continue our dialogue to ensure that it is fixed.

[Sir Vince Cable (Twickenham) (LD)]

The Minister will be aware of the close and often tragic link between mental illness and suicide, which is now the biggest killer of young people and is at record levels. What specific measures do the Government have to address that issue?

[Jackie Doyle-Price]

The right hon. Gentleman will be aware that we expect all local communities to have suicide prevention plans, part of which will be that they engage in areas of greatest risk, whether it be regarding place or their populations. Suicide is the biggest killer of young people and I expect local authorities to engage with education providers to make sure that sufficient measures are in place. We are in the process of challenging the plans to make sure they are fit for purpose.

[Paula Sherriff (Dewsbury) (Lab)]

Universities UK has warned that it simply cannot keep expanding to fill the gaps left by inadequate funding for NHS services, after university spending on mental health services rose by almost half in five years. Too often other sectors such as education are left to fill the funding gap this Government have left in mental health, so can the Minister tell me today when her Government will match our pledge to ring-fence funding for mental health?

[Jackie Doyle-Price]

I have always viewed the ring fence as a ceiling rather than a protection. We have the mental health investment standard and NHS England is challenging clinical commissioning groups that are not spending what we would expect.

This is a systemic weakness. We have treated children up to 18 and then considered them as adults, but the reality is that people do not suddenly achieve majority overnight. We intend through the forward plan to have the children and young people service from nought to 25. That should enable transition and stop people falling off the cliff edge at 18.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

5. What recent assessment he has made of the availability of prescription drugs.

--- Later in debate ---

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

11. What recent assessment he has made of the effect on patient outcomes of regional variations in mental health funding.

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

Funding allocations to clinical commissioning groups vary to meet the needs of local populations, including mental health needs. These allocations are determined by a formula managed for the NHS by the Advisory Committee on Resource Allocation. For mental health, the formula takes into account patient-level data covering community, out-patient and in-patient mental health services, as well as improving access to psychological therapies activity and hospital episode statistics.

[Gill Furniss]

One in three early intervention in psychosis services in the north of England does not meet the standard that NHS England expects. What is NHS England doing to end this postcode lottery and ensure that my constituents can access the same high-quality mental health services as people in other areas of the country?

[Jackie Doyle-Price]

The hon. Lady is right to highlight this. Good care depends not only on money but on performance, and we expect the Care Quality Commission to be very challenging in inspections so that we can guarantee consistency in the quality of services, rather than experiencing the postcode lottery she mentions. I am disappointed that the CQC rated Sheffield Health and Social Care NHS Foundation Trust as requiring improvement following the inspection in May and June last year, but we expect that challenge to continue so that there are obvious improvements.

[Steve Double (St Austell and Newquay) (Con)]

The additional money for mental health in the NHS long-term plan is very welcome, but does the Minister share my concern that it is essential that that money reaches the frontline and results in improved services and improved access to services? What steps is she taking to ensure this money does result in improved services?

[Jackie Doyle-Price]

My hon. Friend will know that, in addition to the additional £2.3 billion, we are clear that this money will lead to more rapid treatment. NHS England will also be giving a really direct challenge to clinical commissioning groups and trusts to make sure improved services are delivered on the frontline.

[Greg Hands (Chelsea and Fulham) (Con)]

12. What steps he is taking to increase the number of nursing associates in the NHS.

--- Later in debate ---

[David Duguid (Banff and Buchan) (Con)]

16. What steps his Department is taking to increase awareness of rare, genetic and undiagnosed conditions in mental health services.

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

Steps to increase awareness of rare conditions in care settings and speciality services, including mental health services, are being taken through the implementation of the UK rare disease strategy. The Department published an update to its implementation plan for achieving the commitments and strategy in England in February this year to coincide with Rare Disease Day.

[David Duguid]

I thank the Minister for her answer. Specific mental health problems are common symptoms of the genetic and often undiagnosed condition of 22q11.2 deletion syndrome and therefore many people with the condition need access to knowledgeable mental health services, but families often report being unable to get the support that they need. With Mental Health Awareness Week fast approaching, will the Minister meet me to discuss increasing awareness of 22q11.2 among NHS mental health practitioners and ensure that people with the syndrome can access the services that they need in all parts of the United Kingdom?

[Jackie Doyle-Price]

I thank my hon. Friend for his question. Of course I will be happy to meet him. He is right to identify the fact that people with long-term conditions are more likely to suffer from mental ill health. It is very important that we achieve good care co-ordination so that all those issues can be tackled in the round. We will continue to work to ensure that professionals are made aware of these conditions.

[Kerry McCarthy (Bristol East) (Lab)]

I have spent much of the past week supporting the parents of a child who has a very, very rare genetic condition and who now needs the support of child and adolescent mental health services. It has become very clear to me that CAMHS is set up only to deal with mainstream children who can go through perhaps its anxiety counselling courses and who can process information in a certain way. It does not seem at all geared up to help children who have very complex needs and perhaps learning disabilities. What can we do to make sure that those children who are more vulnerable are not left behind?

[Jackie Doyle-Price]

The hon. Lady is entirely right. I am particularly concerned about the impact on young people going through a period of mental ill health who have neurodiverse conditions and other conditions. It is very important that we tackle the entirety of the individual’s need. Clearly, we need to do more to make sure that all children with whatever conditions can access help when they need it.

[Mr Speaker]

My ambition is to reach Question 17 so that the House, Mid Sussex, the nation, the European continent and the world can hear the right hon. Member for Mid Sussex (Sir Nicholas Soames).

--- Later in debate ---

[Antoinette Sandbach (Eddisbury) (Con)]

18. What steps he is taking to promote stem cell donation.

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

Since 2011, the Department has provided more than £26 million to NHS Blood and Transplant and to Anthony Nolan, to improve stem cell donation, and is now establishing a unified UK stem cell registry. I would also highlight the inspirational work of Team Margot, who are working to increase the number of people on that stem cell register by enrolling themselves in the transatlantic rowing race. I urge all hon. Members to support that campaign.

[Antoinette Sandbach]

I hope the Minister will join me in praising my constituent Peter, who has myeloma and set up the “10,000 donors” register. There are now 22,000 donors registered, but Peter has a rare ethnic mix of English, Irish, Chinese and Portuguese. What more can be done to encourage donors from minority communities?

[Jackie Doyle-Price]

My hon. Friend is absolutely right. We have spent a lot of time encouraging donors from minority communities, but the real issue with regard to stem cell donation is that it is about genetic composition. We live in a wonderful society where we all have heritage going back in various, very complex ways, but that makes finding a suitable donor for stem cell donation extremely difficult. It is therefore important that we encourage people to take the test to establish their genetic heritage so that we can have more and more diverse people on the register.

[Sarah Newton (Truro and Falmouth) (Con)]

20. What recent steps Public Health England has taken to help ensure that the violence against women and girls service commissioning guidelines are implemented throughout the NHS.

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

I thank my hon. Friend for her important work on the whole issue of violence against women and girls. Clinical commissioning groups are the primary commissioners of NHS services, and, as such, play the lead role in ensuring that service commissioning guidelines on violence against women and girls are implemented through the NHS, as informed by evidence available and current guidance.

[Sarah Newton]

Public Health England is planning to update the public health outcomes framework this summer, but there are no planned outcome measures for victims of domestic abuse or sexual violence. Will my hon. Friend liaise with the Home Office and the clinical commissioning groups to consider measures so that we can all be confident that victims are getting timely access to appropriate services?

[Jackie Doyle-Price]

My hon. Friend is knocking on an open door, because this issue is very close to my heart. The public outcomes framework does include a measure of reported domestic abuse incidents and crimes that is intended to give an indication of the scale of the issue in each area, and we expect CCGs to commission services as a response to exactly those issues. I have written to CCGs to remind them to commission appropriate sexual violence services, as well as those already commissioned by NHS England so that we have proper support for people who have been victims of these terrible offences.

[Mr Laurence Robertson (Tewkesbury) (Con)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

T3. Maternity Action reports that migrant women requiring maternity care from NHS hospitals are being deterred from receiving treatment by charges and fear of immigration sanctions. Will the Secretary of State meet me and campaigners to discuss what we can do to address that worrying situation?

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

The issue that the hon. Lady raises is very concerning. I would be more than happy to meet her to look at that.

[Martin Vickers (Cleethorpes) (Con)]

T9. Some 1,486 of my constituents have been diagnosed as suffering from dementia. The Alzheimer’s Society is urging that, to provide the best support and care, carers should have tier 2 training. Is the Minister doing everything possible to achieve that?

--- Later in debate ---

[Bill Esterson (Sefton Central) (Lab)]

T8. Tens of thousands of children are born every year with brain damage as a result of pre-natal exposure to alcohol, yet most clinical commissioning groups are not providing support for those with foetal alcohol spectrum disorders, despite Government guidance telling them to do so. Will the Government take the action needed and provide support for those suffering with this life-limiting and lifelong condition?

[Jackie Doyle-Price]

The hon. Gentleman is right. Foetal alcohol spectrum disorders are not sufficiently widely understood across the NHS. We must ensure that we give support to those who are affected and also raise awareness, not least to encourage people to understand the risks they are taking when they drink alcohol during pregnancy.

[Mr Steve Baker (Wycombe) (Con)]

Over many years, High Wycombe has established a dramatic way to help tackle obesity. To that end, a week on Saturday, the mayor, a number of councillors and I will be weighed in public, to check whether we have put weight on at taxpayers’ expense. If the Government wish to extend that programme to other Members of the House, I will be happy to ask to borrow the weighing tripod.

--- Later in debate ---

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

As the Minister is aware, I have become concerned about the rising number of suicides in my constituency. When I talk to professionals in the area, they tell me that it is not just funding that is causing some of the problems but the lack of staff. What more can the Minister do to ensure that we have the mental health staff that we desperately need?

[Jackie Doyle-Price]

I am grateful to the hon. Lady for raising that. She is right to do so. We are aware of some of the specific issues in her constituency, and I look forward to visiting and taking up some of the discussions directly.

[Rachel Maclean (Redditch) (Con)]

The Secretary of State has been kind enough to visit Worcestershire Royal Hospital, which serves people in my constituency. He saw for himself how small the emergency department is there. With £20 billion going into the NHS, does he agree that there is a good opportunity to look again at returning services to Redditch—in particular, the maternity and A&E departments, which have been removed?

Infected Blood Support Scheme

Jackie Doyle-Price Excerpts

Tuesday 30th April 2019 Written Statements

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

Today the Government have announced their intention to increase the financial support for beneficiaries of the infected blood support scheme in England, administered by the NHS Business Services Authority (NHSBSA).



This follows a meeting on 21 January 2019 between myself, the Chancellor of the Duchy of Lancaster, the infected blood inquiry secretariat and affected beneficiaries where I committed to looking at where further improvements might be made to the support provided by the existing infected blood scheme.



In this announcement, we have set out our plans for a major uplift in the financial support available to infected and affected beneficiaries of the infected blood support scheme in England. The current annual cost of the scheme is estimated at £46.3 million per annum and we expect this will increase to over £75 million to provide for these uplifted payments.



The level of support provided to infected beneficiaries will increase. In addition, the upper threshold level of household income currently used to means-test support provided for the bereaved will also be substantially raised allowing more bereaved beneficiaries to be eligible for additional support from the scheme.



All beneficiaries will be sent a letter by NHSBSA this week setting out the details of the changes and the impact they will have on them. This detailed payment information will also be made available on NHSBSA’s website. All new payments will be backdated to 1 April 2019.



I have also announced my intention to reach out to the devolved administrations to look at how we might provide greater parity of support across the United Kingdom. I will update hon. Members on these conversations in due course.



Today’s announcement reconfirms the Government’s commitment to providing those affected by the infected blood tragedy of the 1970s and 1980s with a fair and transparent support scheme, one which focuses on their welfare and long-term independence.



It also reaffirms the Prime Minister’s support for the infected blood inquiry, which she ordered in 2017, and which specifically asked for the support given to those affected by infected blood be looked at again. The Government will continue to listen to and co-operate fully with the inquiry.

[HCWS1527]

Hormone Pregnancy Tests

Jackie Doyle-Price Excerpts

Tuesday 23rd April 2019 Westminster Hall

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

I thank all hon. Members who have participated in the debate, with real passion and determination to get to the truth. I fully accept the perception held by all Members present that we have waited a long time for answers.

One of the reasons I have pushed so hard for the Cumberlege review is exactly those arguments that have been made here this morning. It is important that everybody who has been affected is able to get answers. We have heard lots of talk today about a cover-up, and there clearly needs to be confidence in the review’s outcome. That is why I wanted Baroness Cumberlege to take an objective look at exactly what has happened, as well as recognising that the way in which the regulatory system has dealt with concerns has seemed very inhumane, process-driven and extremely insensitive to patients. The response on issues of patient safety must be improved. I am really looking forward to receiving Baroness Cumberlege’s recommendation in that regard, because so many people’s experiences have been entirely unsatisfactory. I know that she has considered the evidence brought to her by Marie Lyon and Jason Farrell. I will be taking the recommendations extremely seriously and I hope that she can draw some conclusions on where everything has gone wrong.

The hon. Member for Bolton South East (Yasmin Qureshi) and others raised the issue of the independence of the Medicines and Healthcare Products Regulatory Agency. It is entirely appropriate that regulators are funded by the community that they regulate, through fees. That in itself does not lead to questions on the regulator’s independence, but we need to offer some challenge in order to see whether the processes have sufficient integrity in terms of the response on issues of patient safety. I do not think we tackle the question of independence solely by shifting the funding on to taxpayers. It is entirely appropriate that the industry should meet the cost of regulation, but the review will bring some conclusions on whether that medical regulation is operating properly.

While we await the review’s conclusions, we have had the expert working group. It is clear that hon. Members are not entirely confident in the processes and conclusions of that group. To put the work in context, the group gathered evidence from around the world and met seven times over an 18-month period. It concluded unanimously that the totality of the data reviewed did not support a causal association between Primodos and adverse pregnancy outcomes. It also did not conclude that there was not, and we clearly need to consider any further evidence when it is brought forward.

[Hannah Bardell]

I appreciate the comments that the Minister is making. She must recognise that the MHRA had ultimate control over what the expert working group saw, and that many documents that Sky’s Jason Farrell had uncovered in Berlin and which Members have cited were not included in the work of the EWG. We need a fully transparent review—as the right hon. Member for Hemel Hempstead (Sir Mike Penning) said—under oath. Does she agree that that would be sensible?

[Jackie Doyle-Price]

I come back to my opening comments: we brought forward the Cumberlege review to give an independent challenge to what is currently being done by a regulatory system. We need to look at whether that system is appropriate, given the concerns.

[Gordon Marsden]

The Minister is being very generous with her time. She is seeking to persuade us, perfectly reasonably, that she and the Government have been acting in a measured way to try to look into all these things. As I have said, we welcome Baroness Cumberlege’s report. Has the Minister at any time asked the members of the expert working group why they changed the definition that they were given?

[Jackie Doyle-Price]

I am not satisfied that that is actually what happened. When we receive drafts of reports that are circulated to committees, they often go through amendment.

Let me continue going through the chronology of events. As I said, the evidence did not support a causal association, nor did it disprove one. We will of course continue to review evidence as it arises.

[Sir Mike Penning]

I think this is a really fundamental point. I apologise if it seems like I am going to give the Minister a hard time, but I am. They were not asked to look for a causal link; they were asked to look for an association, and we have now seen evidence that they knew it was there. I know what happens when the notes are written for the Minister. They were not asked to look for a causal link, but for an association. They decided among themselves to change what they were supposed to look at, which is why they came out with the results that they did. That is a really fundamental point.

[Jackie Doyle-Price]

I hear what my right hon. Friend says. There has to be some element of cause, otherwise there is no scientific basis for a judgment. I will have to agree to disagree with him on that point.

[Sir Edward Davey]

I have to intervene on the Minister on that point. In many cases, drugs are looked at on the probability of risk, not on causality. Causality is a much stronger test. In science, it is very difficult to prove. If her officials are telling her that about a causal link, they are wrong. I urge her to get separate independent advice on that.

[Jackie Doyle-Price]

The drugs are no longer available because of association, due precisely to that balance of risk. The issue that we are looking at now is to what extent that was understood at the time, and to what extent there is a liability. That is what the group is ready to look at.

[Sir Edward Davey]

The Minister is being very generous with her time. I refer her to the evidence that was in the Berlin archives, which goes back to 1968 and 1969, and to the meta-analysis, which proves that on the balance of probabilities there is no doubt. That became known not this year, but years ago.

[Jackie Doyle-Price]

I am answering on behalf of the working group. That is an independent process and I will try to do my best. The right hon. Gentleman raises the issue of the meta-analysis and the suggestion that Parliament has been misled about why that was not done. The expert working group discussed the merits of doing a meta-analysis at its fifth meeting. In its view, the studies were very different, not sufficiently robust and suffered from extensive limitations. The group concluded that conducting a meta-analysis was not the most appropriate way to analyse this type of study. Instead, the group developed a set of quality criteria and presented its assessment of each study in a series of plots. To reconfirm, the data was not considered sufficiently robust for meta-analysis to be used. One of the real problems we have is that we are talking about data that, as we have mentioned, is 50 years old and not sufficiently robust.

There have been some suggestions that the expert working group has been less than transparent. In line with the Government’s commitment to publish the report of the review and all the evidence considered by the group, all documents have been available for public scrutiny since November 2017. We have been very grateful for the involvement of Marie Lyon throughout that process.

There has been some criticism of the lack of an external peer review of the expert working group report. The Government’s independent scientific advisory body on the safety of medicines, the Commission on Human Medicines, acts as the peer reviewer for all expert working groups. It reviewed the draft report on two occasions before it was published. I know that Baroness Cumberlege will be looking at whether there has been sufficient peer review of that report, and I look forward to receiving her recommendations. As with any issue, new evidence can emerge in the meantime. I reassure the House that the Government have made a commitment to review any important new evidence, and we have honoured that commitment.

[Emma Reynolds]

The Minister said a moment ago that the crux of the matter is what was known at the time about the balance of risks. Will she look at international comparisons? In other countries, this hormone pregnancy test was banned much earlier than it was in the UK.

[Jackie Doyle-Price]

I hear what the hon. Lady says. We have taken this work forward with the working group and have been looking at the totality of evidence around the world, particularly in Europe. Last year, Ministers asked the MHRA to convene a group of experts who have been completely without any agenda on this issue in the past, to consider the work by Professor Vargesson and ensure that it was sufficiently independent. That work, which has been referred to, concluded that Primodos caused malformations in zebrafish embryos. We have also asked for an independent European-level review of that evidence to be undertaken, so that everyone can have more confidence in the outcome. Both the UK and European reviews concluded that the results of the zebrafish study had no implications for the conclusions of the expert working group’s report, and the findings of both reviews have been published.

I turn finally to the data published by Professor Heneghan. Although this analysis does not contain any new data, it found the use of hormone pregnancy tests in pregnancy is associated with a small increased risk of certain congenital malformations. The Government have therefore asked for a completely new expert group to be convened in order to consider Professor Heneghan’s work, and for a review to be conducted in parallel with the European review. Those reviews are ongoing, and I look forward to receiving that advice.

I appreciate that I have not been able to satisfy all the representations made by right hon. and hon. Members this morning. As I said, the Government will continue to review evidence in this area. We are still considering the evidence from Professor Heneghan, and we look forward to implementing any recommendations that Baroness Cumberlege brings forward in this regard.

Mental Health Services: Leeds

Jackie Doyle-Price Excerpts

Tuesday 23rd April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Leeds North East (Fabian Hamilton) for the passionate and articulate speech he has made on behalf of his constituents.

I often get frustrated by debates about the NHS, which are all about inputs—how much money is being spent, or what the size of the workforce is—and not enough about the direct patient experience and whether what we have is delivering the right outcomes. The story that the hon. Gentleman has shared illustrates that, for a lot of people experiencing mental ill health, their journey towards getting care is not always optimal. That is for a whole host of reasons, including historical issues regarding process and how people interact with their services. I will go away and take a deeper look at what he has highlighted, because it is a very good example of how things can go wrong.

As I say, the issue is not just about money, because we have made money available to all clinical commissioning groups. The hon. Gentleman has asked why, when we are making money available at an increased rate across the board, mental health services are so much worse in Leeds than elsewhere. As is so often the case with these things, a lot of it is about leadership. One issue that has been specifically raised with me is that often, the person responsible for commissioning mental health services within a CCG is not as senior as others. They are not as experienced, and that can cause weaknesses in commissioning.

It is important that we take action centrally to make sure that we deliver services more consistently, and I expect that to be achieved through the Care Quality Commission. The hon. Member for York Central (Rachael Maskell) raised specific concerns about her local trust. The CQC’s inspection report last year said that the trust requires improvement, so I fully expect it to work collaboratively with the CQC to take the steps that it is advised to take, in order to improve its performance when providing care. That CQC scrutiny will continue until the relevant improvement in performance is delivered.

NHS England also demands that CCGs achieve the mental health investment standard. Under that criterion, CCGs are bound to spend more of the additional money they receive on mental health services than their overall increase in budget. We expect NHS England to take direct action to secure that. However, that is not the whole story, because it depends on what CCGs are commissioning.

One of the messages that I have been keen to give CCGs is that delivering good outcomes for people suffering from mental ill health is not just about clinical services; the voluntary sector can play a big role. I have challenged CCGs to use some of their budgets to commission services directly from the voluntary sector. When someone is suffering a mental health crisis, they need help to navigate the system. In the example that the hon. Member for Leeds North East shared, that help was clearly not forthcoming from the GP.

Having someone with an understanding of mental health who can help a person suffering a crisis navigate through the system is clearly beneficial and, frankly, is good value for money. We should not spend all our NHS budgets on clinical staff when that additional support can deliver so much. In the case that the hon. Gentleman outlined, the GP did not do as much as he could have done, so we perhaps need to consider what else we can do to make sure that GPs understand that system. Again, the voluntary sector has a role to play.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) mentioned having more mental health education in schools, which is an issue that we are taking forward. She specifically mentioned Place2Be, which is a good example of how a third-sector organisation can work with the NHS to deliver the right outcomes. We are in the process of rolling out a whole new workforce in our schools to do exactly as my hon. Friend has challenged us to do.

On people who have attempted suicide, I readily concede that patients in such circumstances have not had a joined-up service between their GPs and their primary care providers. However, through the liaison psychiatry teams that we are rolling out in A&E, we intend to make sure that that wrap-around care is provided more readily.

[Dr Poulter]

Will the Minister give way?

[Jackie Doyle-Price]

I will, although I was just about to come to my hon. Friend’s point.

[Dr Poulter]

Suicides are very unpredictable, and a lot of people who attempt to take their own life were not previously known to services—whether their GP or psychiatric services. The problem with mental health services in Leeds and elsewhere is that community services have been completely hollowed out by funding cuts over many years. Unless we invest in community services to stop people ending up in crisis in the first place, we are not going to solve the problem of suicide or deliberate self-harm, or provide help to those who really need it. I hope that the Government are going to get a grip on that problem and push it through NHS England and CCGs.

[Jackie Doyle-Price]

My hon. Friend is absolutely right. When we try to deliver a transformational step change in the level of service, one of the problems is that we end up raising expectations quicker than we can deliver on them, because we need a whole workforce that is able to deliver. I note my hon. Friend’s points about the number of people applying for psychiatric posts; we need to do much more to encourage people. We have spent a lot of time raising awareness of mental health and put a huge amount of investment into psychological therapies. However, at the heart of the forward plan for the next 10 years is a recognition that we need much more service available in the community, and much more help for people with severe mental ill health. I hope that my hon. Friend is reassured by that.

As I have limited time, I will follow up in writing on the other points made by the hon. Member for Leeds North East. As I said, we have made money available in Leeds, but when we look through the prism of someone who needs help and whose journey in getting that care is less than optimal, we clearly need to consider what is going wrong with that care pathway. If someone is vulnerable and needs help, and perhaps does not have a good understanding of mental health or has no experience of it, the whole process is very confusing and distressing.

How we navigate people through the NHS can often feel very inhuman—it is very reliant on process. The hon. Gentleman gave an example of how people are sent online to register, which feels a bit uncomfortable. We need to make sure that we take every opportunity to ensure that the patient is at the heart of this process and that their experience is pleasant, at a time when they are going through great distress. To say, “Here you are: go to this website—you’re on your own, so see you later,” is not a good start for anyone looking for help.

I am grateful to the hon. Member for Leeds North East for having brought this case to my attention, and I pay tribute to Mr and Mrs Downey for sharing their story, because doing so is incredibly difficult. I will look at the specific points that the hon. Gentleman has raised and come back to him.

Mental Health Support: Young People

Jackie Doyle-Price Excerpts

Tuesday 9th April 2019 Commons Chamber

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

I thank the hon. Member for High Peak (Ruth George) for her speech. She spoke with characteristic passion and sincerity about an important matter that concerns many Members, which is why so many are here tonight. I have personally engaged with a number of them on these issues.

Let me say at the outset that I am not complacent about the challenges that confront us when it comes to children’s mental health. It is true that many young people find it difficult to obtain help when they need it. I readily acknowledge that we face the challenge of decades of underfunding of treatment for mental ill health, in addition to the societal challenges that have made the problem more acute. It is clearly a priority for the Government, but unfortunately we cannot solve it with just a click of the fingers. We need to reinvest in the workforce if we are to deliver the services that are needed.

However, I hope to give the hon. Lady some reassurance about the direction of travel. I hope to reassure her that we will tackle the most acute needs while at the same time investing in the upfront prevention which, as she rightly pointed out, will save the Government money—and not only in the NHS, where there will be less demand for acute mental health services. She is right to highlight the savings that could be made in the criminal justice system. We must achieve the earliest of early interventions if we are really to make a difference, and not just for those people who need support, but for society, and that lies at the heart of my approach.

[Mark Tami]

Does the Minister not realise that young people actually have to try to kill themselves before they become a priority? Surely that is wrong. Early intervention is the key and we must not wait until young people reach that terrible stage before intervening.

[Jackie Doyle-Price]

I am sure that the right hon. Gentleman will be reassured to hear that I do not think that is good enough. I have heard anecdotal evidence that that has been said to a number of people. Clearly it is a matter of clinical judgment when people are referred to mental health services; we just need to ensure that happens. If he has specific examples, I would be happy to investigate them.

[Luke Graham (Ochil and South Perthshire) (Con)]

Mental health is raised with me time and again by my constituents, both young people and parents, in Clackmannanshire and in Perth and Kinross. Can my hon. Friend explain to the House how we can help champion the 111 crisis line, which is available UK-wide? It can be pre-emptive, because a young person can dial it on their mobile phone and get immediate support. Sometimes that pressure release valve is exactly what is needed.

[Jackie Doyle-Price]

My hon. Friend makes an important point. Just as we have the 999 service for physical health emergencies, we need the same provision for mental health emergencies, and that is what we intend to deliver through the 111 service. That is a clear ambition articulated in the forward plan.

[Rachael Maskell]

The Minister said that this is a matter of clinical judgment, but clinicians are unable to make those choices if they lack the necessary staff and resources.

[Jackie Doyle-Price]

There will be cases when it comes down to a clinical decision on whether a referral to a mental health professional is needed. However, we need to ensure that mental wellbeing is embedded throughout our health services.

[Ruth George]

In my area CAMHS are supposed to accept referrals from some of the young people on level 2—that indicates their level of need—and all of the young people on levels 3 and 4. As it is, they do not have time to accept even those children on level 4, which has the highest priority. That is a result of resources, not clinical judgment.

[Jackie Doyle-Price]

That is not borne out by the figures from the Derby and Derbyshire clinical commissioning group, which show that 31% of children and young people with mental health needs were seen by NHS-funded mental health services. I come back to the point that it is not acceptable for children to be told that they are not yet ill enough to receive treatment, which is why we are investing in more provision. We expect at least an additional 345,000 children and young people aged nought to 25 to be able to access more direct support.

[Mr Ivan Lewis]

I have to say to the Minister that in this area there is a massive gap between the rhetoric and the reality on the frontline. I urge her to reconsider the whole concept of ring-fencing resources. When we have Cinderella services such as CAMHS, unless the Government decide to ring-fence that funding and insist that local commissioners give it to frontline services, they will never achieve the changes they are seeking.

[Jackie Doyle-Price]

In the past we have treated ring fences as a ceiling and set CCGs the clear objective that they need to increase investment in CAMHS by more than what we have been giving them. [Interruption.] However, acknowledging the hon. Member for Worsley and Eccles South (Barbara Keeley), we will look at what more control we can give, and NHS England is keeping a very close eye on how that money is being spent. As I said at the outset, I am not complacent about the challenges we face. I have to say that we are on it. Direction of travel is one thing, but we have to make sure that we are managing expectations and that we can deliver the services that people expect. That includes investment in the workforce to deliver on very clear expectations.

[Sarah Newton (Truro and Falmouth) (Con)]

My hon. Friend is being characteristically generous in giving way. I would like to give her some feedback from Cornwall, where our CCG is spending more money on mental health services and I am seeing those services grow. Does she agree, however, that simple organisational changes can sometimes help? I have two universities in my constituency, Exeter and Falmouth. When young people leave home for the first time and arrive at university, it can take months for the NHS to get their records and services sorted out, but young people with existing poor mental health conditions need those services to be in place when they arrive.

[Jackie Doyle-Price]

My hon. Friend makes a good point. Transition is clearly an area that we need to address, and she is right to highlight the importance of this in universities.

The hon. Member for High Peak made a number of points in her speech. She referred to people with ADHD and ASD, and I could not agree with her more that there is a real issue with the failure to diagnose people with those conditions early enough. We know that those people are more likely to suffer from mental ill health, so early diagnosis is absolutely crucial if we are to equip those young people with the tools to look after themselves. I am pleased that that has been a target in the forward plan that we will roll out. The hon. Lady also rightly highlighted the issues surrounding county lines and knife crime, and there is no doubt that the increased incidence of trauma in communities will bring with it more demand for mental health services. That is something that we are very much tackling as part of the Prime Minister’s summit, which took place just last week.

I have been very pleased to work with the hon. Member for Ogmore (Chris Elmore) on this, and I welcome his all-party parliamentary group’s report on the impact of social media. The impact of social media brings with it a whole new set of pressures on children’s and young people’s mental health. It brings greater intensity to relationships, for example. We think our children are safe in their bedrooms, but they are not necessarily, and we need to be vigilant about how we hold social media and internet providers accountable for the content that they host on their sites.

[Jim Shannon]

The Childline charity has reported a 30% increase in referrals in the past year. That is an indication of the pressure being put on our children. Has the Minister had an opportunity to speak to Childline?

[Jackie Doyle-Price]

I have not had that opportunity yet, but I am sure I will.

I could say an awful lot more, but I do not have much time remaining. It is clear from hon. Members’ contributions to the debate that we all recognise that this is perhaps one of the biggest challenges facing our young people right now. It is heartening to see that so many people are really seizing those challenges, whether by demanding better services or by asking for changes to Government policy to deal with some of the threats. That is all very welcome, and I have no doubt that all Members will continue to challenge me on this important issue.

Question put and agreed to.