Health and Social Care Committee

Jackie Doyle-Price Excerpts

Thursday 28th February 2019 Westminster Hall

[Dr Williams]

I thank my hon. Friend for emphasising maternal mental health. The Government have made significant progress in improving services, particularly for people with more severe perinatal health problems, but we still have too many cases where people are likely to develop mental health problems, even if those problems are not predicted, and who say they have mental health problems in the perinatal period, but services do not detect those problems. The National Childbirth Trust has estimated that perhaps up to 50% of mothers with perinatal mental health problems never get asked about their mental health. It is welcome that some areas of the country are responding to that issue in an assertive way and seeking to prevent perinatal mental health problems, rather than just detecting them early. However, we are left with a lottery, whereby some areas do this work exceptionally well, and other areas still have to catch up.

The idea of a local authority-led plan, with some central accountability, might help to bring the kind of services that are obviously being provided already in Dewsbury to many other parts of the country.

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

May I, too, thank the Committee for its excellent report?

As Members are aware, tackling inequalities is part of my brief and, frankly, there is no more obvious place to start than in the very early years. If we can get all children a good start, we will not only be well on the way to making life better for them, but will, as the hon. Member for Stockton South (Dr Williams) has observed, make savings for the taxpayer, too. I encourage him to continue pushing this work. As he is aware, prevention is very much at the heart of this Secretary of State’s agenda, and what we can do in the first 1,000 days is clearly a big part of prevention.

I note that the hon. Gentleman will meet the Leader of the House very shortly. He will find that she is very enthusiastic about and receptive to a lot of the themes that are discussed in this report, so my message—indeed, my plea—to him is this: please carry on with this work.

[Mr Virendra Sharma (in the Chair)]

It is the end of the time for the statement and questions about it. Thank you all very much. We move on to the next debate.

Eating Disorders Awareness Week

Jackie Doyle-Price Excerpts

Wednesday 27th February 2019 Westminster Hall

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

I thank all hon. Members who have contributed to this very constructive debate. They all showed massive care and compassion, with a recognition that we have come a long way but need to go a lot further. I am grateful for their constructive contributions.

I congratulate my hon. Friend the Member for Angus (Kirstene Hair) on securing this debate in Eating Disorders Awareness Week. I thank her for her very frank exposition of eating disorders, and of the helplessness felt not only by those who are suffering, but by those around them. It is essential that we ensure that people have access to the right mental health support in the right place and at the right time, because time is of the essence. Improving those services is a key priority for this Government, as part of our wider agenda to improve mental health services.

As several hon. Members have said, eating disorders are serious: they have some of the highest mortality rates of any mental health disorder. We need to ensure, more than ever, that people get access to support as early as possible, because eating disorders quite often begin when people are young. Representations have been made today about why our targets are for children, rather than adults. Those targets recognise the fact that early intervention is best and that issues often surface when people are younger, but that does not in any way diminish the challenge of ensuring that adults also have access to services.

That brings me to a point that several hon. Members have made: the perception that eating disorders affect only young white women. They do affect adults. I have heard of a case of an elderly lady in a care home being diagnosed with an eating disorder that she had obviously been suffering from for decades. One of the tests that I will set myself is for that never to happen again, because we need to ensure that people get early diagnosis.

As the hon. Member for Islwyn (Chris Evans) very frankly reminded us, eating disorders affect men and boys too. If there is a perception otherwise, it may partly be because men and boys are much less likely to seek help than women and girls. We need to make it clear that the issue can affect absolutely anyone, as the hon. Gentleman showed very courageously by sharing his own experience; I am very grateful for his comments.

It is important to continue to raise awareness. We need to reduce the stigma associated with eating disorders so that people are more likely to talk about them. Like all hon. Members, I pay tribute to the campaigners who do so much to raise awareness, particularly the charity Beat, which does absolutely excellent work. I also pay tribute to Hope Virgo for her campaign and look forward to meeting her very soon.

We cannot emphasise strongly enough that this is not about weight; it is about the mind. Some of the stories that were shared in this debate were quite horrific. If there is such lack of understanding among medical professionals—if the people we trust to look after us end up doing harm because they see eating disorders as a weight issue—we have a serious problem to tackle. Of course training has its part to play, but I should add that we expect a lot of our GPs. One of the real challenges is to continue to roll out multidisciplinary GP service teams to ensure that there is much greater expertise in each medical practice, rather than relying on one individual to be the expert on everything. Frankly, they are only human beings—they are not God.

[Wera Hobhouse]

I thank the Minister for giving way; I know that her time is very limited. When services let people go too early, the danger of relapse is much higher. We could prevent relapses by not letting sufferers go too early, when they are half better but not fully better.

[Jackie Doyle-Price]

The hon. Lady makes a good point that I will address further if I have time. We need to look carefully at the care pathway and at the whole practice of referrals and the journey that people take, so that we can ensure that they are in a position to manage their disorder. The truth is that no one is ever cured of these things; it is a matter of managing their wellbeing to tackle them.

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for her acknowledgment that we have come a long way. She is right that we need to ensure that we have proper specialist services to do this work, because of the risk of harm. She is also right to mention obesity, which we could do an awful more to address. I watch a lot of rubbish TV—we work long hours here, so that is my relaxation—and I am horrified by some of the channels, which basically run a succession of programmes about weight that are almost freak shows. That is not how we should be talking about the issue if we want to encourage people to access help. We need to tackle the stigma around obesity as much as the stigma around any other disorder.

The hon. Member for Westmorland and Lonsdale (Tim Farron) and I have already discussed his concerns about his area. I know that there are challenges and we need to ensure that provision is sufficient. He spoke very frankly about the guilt and terror that people around those who suffer from eating disorders feel, because they genuinely do not know how to help their friend or loved one. Reducing stigma and raising awareness is partly about helping people to understand what they can do. Everybody wants to help, because nobody wants to see people suffer so much.

Social media has been mentioned a lot. I absolutely recognise that it can be a force as much for good as for bad, but I must say that we are seeing content that encourages harmful behaviour. It is about the whole psychology of people joining communities. When people use social media regularly, they can become isolated from the physical world and join an online world in which everyone is like them. It becomes normalising, and it can worsen their experience.

Equally, social media can be a community of self-help. I agree completely with the hon. Member for Islwyn that we have to be careful: of course we must challenge companies to be responsible, but it is not black and white, and we need to handle the issue sensitively. I am pleased to say that some companies are very responsive, but not all, so we will continue to challenge them. The hon. Gentleman raised an issue that particularly concerns me. It is one thing to regulate public platforms, but encrypted direct contact is having a growing impact. We need to look at Snapchat, WhatsApp and so on, because the fact is the Government are always three steps—probably more—behind technology.

The hon. Member for East Kilbride, Strathaven and Lesmahagow emphasised peer support. I could not agree more: peer support is important for mental health generally. If I could make one challenge to NHS commissioners, it would be to recognise that providing support to people who suffer mental ill health is not just about clinicians; it is about the voluntary sector and peer support workers. If we are to really step up to that challenge, I hope to see much more imagination in how services are commissioned.

I have so much more to say, but I am running out of time. With hon. Members’ indulgence, I will write to them—not least the hon. Member for Newcastle-under-Lyme (Paul Farrelly)—to outline our response to the points that they raised. We have a lot of figures and have shown that we are meeting targets, but I think all hon. Members would be more confident if there were more granularity—not least because of the cases raised today in which people have not received the treatment that they deserve.

Motion lapsed (Standing Order No. 10(6)).

Former British Child Migrants: Payment Scheme

Jackie Doyle-Price Excerpts

Tuesday 26th February 2019 Westminster Hall

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

Thanks very much, Mr Hollobone, for calling me to speak. It is a pleasure to serve under your chairmanship, and I genuinely thank you for offering me the opportunity to speak very briefly.

Clearly, it will be difficult for me to sum up a debate that I have only heard a tiny fraction of, but I congratulate the hon. Member for Wigan (Lisa Nandy) on securing it. She secured a similar debate something like seven or eight months ago. She has done Parliament a favour by drawing attention to this issue; most importantly, of course, in doing so, she has helped the survivors of these horrible child migration programmes. I thank her for bringing this issue to Parliament once again.

As well as the independent inquiry into child sexual abuse, which we discussed last time, there is the inquiry established by the Northern Ireland Executive and chaired by Sir Anthony Hart, who has also reported in detail on the child migration programmes, and the Scottish child abuse inquiry under Lady Smith, which is ongoing. As was well discussed and well established in our previous debate, even if they are looked at by the standards of the time, these programmes were appallingly ill-conceived, and the actions and supervision of those involved fell drastically short of the standards that were expected. Concerns about the programmes were ignored, and little effort was made to ensure that the children being “exported”, to use that horrible term, were safe.

The conclusions of the IICSA report were stark: successive Governments had failed to respond properly to concerns that were raised, and the programmes were allowed by successive British Governments to remain in place, despite a catalogue of evidence showing that children were suffering ill treatment and abuse, including sexual abuse. The shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), talked about some of the reasons why these programmes were allowed to continue, including politics, which chimed with what we discussed last time.

After the Ross report in 1956, nothing was done. It is stomach-churning to read the IICSA report’s conclusion that that was because of the patronage of persons of influence and position. It is clear that in some cases, the avoidance of embarrassment and reputational risk was more important than the institutional responsibilities towards migrated children. That is a truly damning indictment of successive Governments.

Both the Northern Ireland and the IICSA reports recommended compensation payments for those who had been sent abroad under the child migration programmes over and above any compensation for other wrongs and abuses suffered. The Government’s announcement of the compensation is very welcome indeed, and it is only fair to reflect on the fact that it has been welcomed by groups working on behalf of survivors, including the Child Migrants Trust and the International Association of Former Child Migrants and their Families, and also by former child migrants themselves, who have given evidence to the inquiry.

It is important to hear more from the Government. A statement would have been ideal. We need to know much more about the detail. How has the compensation been calculated? What is the timing? How are folk to apply? Will the Government continue to work with all the groups to ensure that the compensation scheme operates smoothly and reaches as many survivors as possible? After the Windrush scandal, there have been welcome announcements about compensation and redress, but the proof is always in the pudding, and there have already been trials and tribulations in getting that up and running. We do not want that repeated here.

I look forward to hearing what the Minister has to say. I apologise once again for not having been able to play a full part in the debate, and I again thank the hon. Member for Wigan for securing it.

5.1 pm

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

I would normally start by saying that it is a pleasure to engage in the debate, but to be honest this has not been the most comfortable of subjects on which to speak on behalf of the Government. As we have heard, this was a shameful episode in our history, and all the more shaming that it was under successive Governments of different colours. I think everyone in the room would wish to dissociate themselves from that kind of behaviour.

However, I congratulate the hon. Member for Wigan (Lisa Nandy) on bringing the matter to my attention, again. She has been my conscience on this. Quite rightly, because, as she mentioned, we had the recommendation almost a year ago and it took time to get cross-Government agreement on how to take it forward. Having got that agreement, it was my desire that we make progress with the implementation but, by definition, that has left a number of questions unanswered. I hope that some of the points I make today will answer some of those outstanding questions and settle any anxiety that the child migrants have. Ultimately, they have not been dealt the best cards over the years and it is important that we do our very best to redress the situation. I pledge to continue to do my best in that regard.

The hon. Lady rightly highlighted that there was confusion about who owned the policy, and that is one reason it has taken so long. This all came about because of the child abuse inquiry, which sits under the Home Office, but historically the Department of Health has had responsibility for child migrants generally, and that led to the confusion. I really hope that we can settle the matter more formally, so that we can have more certainty for the child migrants. While I am in this place, the hon. Lady can rest assured that she can always nag me if things go awry, and history tells me that she will. All power to her elbow for doing that, because it is important that we do this right.

Once we had made the decision to make the payments, it was important to make the announcement quickly, not least because some of the individuals are elderly—I am advised that the eldest is 102. Speed is of the essence, to ensure that everyone can get some enjoyment from the payments.

The hon. Lady has once again demonstrated her commitment to ensuring that the welfare of those children is not forgotten; we should never forget what was done in our name. The policy was misguided and wrong, and has caused suffering and distress. The conclusion of the child abuse inquiry was that payment should be made not because people were exposed to abuse—compensation exists for that—but because of the very fact that organisations of the state sent the children away without consent. It is in that spirit that we have adopted the recommendation, recognising that organisations of the state exposed the children to harm, regardless of whether any harm materialised. As a consequence, we have taken the opportunity to announce the payments.

All Members have made very fair points about how the scheme has been communicated. That came about, again, because of the speed with which we wanted to make the announcement. It is also worth noting that the Child Migrants Trust has extremely good relationships with the affected people, so although it was not bells and whistles, we were, in a way, using the right channels to get to those who needed to know. However, we will reflect on what has been said and consider whether and how best to disseminate more information, recognising that not all those affected are necessarily in contact with the trust and it might be a pleasant surprise for them to know about the scheme.

As I mentioned, the payments are on the basis of being exposed to risk; they are not compensation for abuse. We have announced that each former child migrant will receive £20,000 in recognition of that exposure. It is only fair that, in recognition of the passage of time since the recommendation, we backdate the payments to 1 March 2018. As the hon. Lady mentioned, a number of the individuals have passed away since that date, and we will honour any claim made in respect of a deceased migrant.

[Lisa Nandy]

The wider communication of the policy is important precisely because of that group of people who have passed away. I imagine that their relatives would be much less likely to look at the Child Migrants Trust website and much more likely to look at gov.uk or the Department of Health and Social Care’s site. If the Minister would at least consider putting something on the Government’s website, that would be helpful.

[Jackie Doyle-Price]

I will take that point away. Part of me thinks that it will be appropriate to do that once we have all the details written down; none the less, I will reflect on what the hon. Lady says, because she is right. The very act of making the payments is in itself an acknowledgement that the Government have failed their own citizens. If individuals are no longer here to enjoy the benefits of the payments, they would have wanted their families to do so, and we need to make every effort to ensure that they can.

As I have said, this is not compensation; it is a payment for the fact that the individuals were deported by organisations of the state and were put at risk of harm. There are other routes to compensation for migrants who suffered harm or injury and this payment is in addition to and does not interfere with that; it does not affect the rights of any individual to pursue avenues of compensation. The scheme provides for an equal award for every applicant, regardless of income. Essentially, we want to make it simple, and to get the payments out to those affected.

Setting the amount was difficult, because it is impossible to put a figure on the costs, the damage and the harm; in that sense, it is difficult to come up with any calculation. But we have engaged with the Child Migrants Trust, which many migrants trust to represent their views, and have consulted it on the design of the scheme. We did not want to go through a formal consultation process for exactly the reasons we have discussed: we wanted to act promptly and in a way that would get the money out as soon as possible. In setting the sum at £20,000, we have taken note of the recommendation of Sir Anthony Hart’s report into institutional abuse in Northern Ireland. He recommended that the payment should be a sum sufficient to recognise the injustice that young children suffered through being sent to a far-away land and losing their sense of identity as a result. He recommended the figure of £20,000, and on that basis, we considered it to be an appropriate figure for a UK-wide scheme. Again, it is important that we do not have any discrimination between the four nations; it is right that we deliver this scheme in a way that is consistent across them.

[Lisa Nandy]

It would be helpful to those child migrants if we could get some clarity about why Sir Anthony Hart came up with that amount. The aim is not necessarily to question that amount, but if we are seeking to put a figure on the level of harm and dispossession that was caused, those child migrants would appreciate—and indeed are entitled to—an explanation of how the amount was arrived at. If the Minister’s office could help us find out how that figure was arrived at in Northern Ireland, that would help many of those child migrants to put together an important piece of the puzzle.

[Jackie Doyle-Price]

That is a fair challenge. With the caveat that any figure would not be adequate to compensate for harm, some methodology about why that figure was arrived at would be helpful.

The issue of eligibility has been raised on a number of occasions. The only condition that needs to be met is that a claimant is a former British child migrant sent from the United Kingdom and Crown dependencies before 1971, meaning anyone who was below school leaving age and was sent by a church, state, voluntary or other organisation to one of the receiving countries: Australia, New Zealand, Canada and Zimbabwe, formerly Rhodesia. However—to answer one of the hon. Lady’s questions—they must not have been accompanied by an adult family member or guardian, sent by an adult family member or guardian, or sent to live with a member of their birth family, because this payment is rooted in the fact that these were people who were sent by organisations of the state. I recognise the point made by various hon. Members that those sent by family members may also have been exposed to abuse, but again, the scheme does not alter those people’s routes for seeking compensation in other ways. This scheme is the Government taking responsibility for decisions made in their name, rather than for those made by families.

We have kept the eligibility criteria as simple as possible, to make the process of claiming the payment as simple as possible. Those eligibility criteria are the same as those being used for the family restoration fund, and are the same criteria that the Child Migrants Trust has used over many decades to determine who can access its services. Clearly, we want to make the application process as simple as possible, and as the hon. Lady has mentioned, we have asked the Child Migrants Trust to act as the first point of contact for child migrants who wish to apply for payments. I have heard the hon. Lady’s points about resource: we are in close contact with the Child Migrants Trust and give it support as appropriate. I hope, given the extensive network of contacts that the trust has, that this work should not prove massively onerous; in fact, in some respects, it may be helpful to the trust’s wider work.

[Lisa Nandy]

It would be helpful to the Child Migrants Trust if the Minister were to agree to a further meeting with the trust to discuss some of those outstanding concerns. I would be grateful for an assurance that she will do that.

[Jackie Doyle-Price]

We will of course continue to engage with the Child Migrants Trust, especially given that we want to be sure that in rolling out this scheme, we are getting to as many people as possible and doing it as efficiently as possible. I do not think anyone is better placed to advise us than the Child Migrants Trust.

The trust will reach out to all those who it has supported in the past to help them to apply for the payment. I know that it has already promoted the scheme widely, and it has also contacted all of the known sending agencies—those organisations that were responsible for sending children. We are aware that there has been extensive coverage in the Australian media, but we will look at where there is a need for further active communication, and how best to do that. We expect the high commissions in Australia, Canada, New Zealand and Zimbabwe to have extensive contact programmes, making sure that they are using their networks to make people aware of the scheme. Those former child migrants who have not previously been supported by the Child Migrants Trust will need to go through a separate application process, but the trust has given undertakings that it will help those people to do so. We have evidence that a number of child migrants who were not previously in contact with the trust have made contact, which is an indication that the message is going out. We have put some details of the scheme on the Government’s website, but I will make sure that we keep that website properly updated so that it is signposting people to where they can access help.

The hon. Member for Wigan is right that although the Child Migrants Trust will accept applications, the actual application payments will be made by the NHS Business Services Authority. The aim is to make those payments within 60 days, but more quickly if at all possible: we are determined to get these funds to those who should benefit from them as quickly as possible. Some reference was made to tax and benefit issues, and I am clear that every one of those beneficiaries should receive that £20,000 in its entirety, free of tax and separate from benefits, but that is not entirely in our gift. We are having conversations with overseas Governments about that issue, and we will also look at what needs to be done for those who are resident here so that they are not adversely affected.

Again, part and parcel of having made an announcement very quickly and then trying to get a scheme going is that we do not have firm answers on all of these subjects. I assure the hon. Lady that I am determined that these people should get this sum in its entirety, and I will do my best to make sure that that is the case. It should be noted that the majority of recipients live in Australia, with significant numbers living in other countries and only a very small number living in the UK. Experience tells us that the Australian Government are sympathetic to this group of people, so I hope that we can make representations that are received sympathetically, even though we have no power to dictate the tax, welfare and benefits arrangements of other countries.

I hope that hon. Members are reassured by some of the details that we have announced. Clearly, the scheme is not as buttoned down and finished at this stage as we would like it to be, but the fact that we have proceeded to implement this decision as soon as it was taken is an indication of how committed we as a Government are—and, in fact, all political parties are—to putting right a wrong that, frankly, has been a cause of shame for so many of us. Nothing can repair the damage that has been done to those individuals. We can acknowledge it, we can apologise, and we can make these payments, but the most important thing that all of us in this room can do is to make sure that nothing so unjust ever happens in the name of the state again. At a time when some of our colleagues are distracted by other issues, this debate is a reminder of why so many of us got involved in politics in the first place—to fight for justice, to right wrongs, and to champion the rights of people who perhaps have not had them championed before.

I will conclude by again congratulating the hon. Member for Wigan, who has been dogged in her determination to do right by this group of people. In doing so, she has made my life uncomfortable from time to time, but I thank her for it, because that is what this place is all about. We will make sure that we deliver as we have promised.

Exiting the European Union (Medicines)

Jackie Doyle-Price Excerpts

Tuesday 19th February 2019 Commons Chamber

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

I beg to move,

That the draft Medicines for Human Use (Clinical Trials) (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 23 January, be approved.

Before I discuss the regulations, it is important to reiterate that we wish to retain the closest possible working partnership with the EU to ensure that those engaged in clinical trials can continue to develop innovative and cost-effective treatments and that patients recruited in trials can continue to have timely access to medicines. However, we are bringing forward this legislation to continue preparations for no deal, in case we need to be prepared for that eventuality.

In developing this amending legislation, my Department’s priorities have been to minimise any disruption to ongoing trials and to make sure that the UK regulator can still protect public health and, importantly, that the UK’s biomedical, health and life sciences research sectors can continue to be world-leading. With that in mind, the Medicines and Healthcare Products Regulatory Authority has sought to take a pragmatic and proportionate approach in establishing the new regulatory requirements. Importantly, that has been done through continued close co-operation with stakeholders. After a period of informal consultation in August, the MHRA published an initial proposal, and it followed that up with further consultation. The feedback from that consultation, which received over 170 responses, led to the statutory instrument before us.

Let me bring a few details to the attention of the House. First, wherever possible, we have sought to maintain existing arrangements. Given that the system for clinical trials is currently based on national-level decision making in the EU and globally, we have not had to make any substantial change in some key areas. In particular, on the ability of the UK to participate in multinational trials in the EU or in the rest of the world, there will be no change. Also, the data gained from trials in the UK can still be deposited in international repositories and be accessed by others. I think the House will agree that that reflects our approach, which is to continue multinational co-operation on clinical trials.

In other areas, we have faced a choice regarding the UK’s regulatory requirements. In those instances, we have sought to maintain current arrangements, provided that the regulator still has sufficient ability to protect public health. For example, we will continue to recognise existing approvals, so there will be no need to reapply for both regulatory and ethics approvals. We will have the same information requirements as the EU for any new applications for multi-state trials in the UK. There is also a requirement that a clinical trial sponsor or legal representative for clinical trials in the EU should be based in the EU. That will ensure continuity of the existing clinical trials landscape and maintain the UK as an attractive, open environment in which to conduct clinical trials.

[Daniel Zeichner (Cambridge) (Lab)]

The Minister is making an important speech. Does she recognise industry concerns about the introduction of an extra level of regulation through the proposals for a qualified person requirement? There is a worry that it will make our country a less attractive place to conduct clinical trials, which are, of course, extremely important to my part of the world.

[Jackie Doyle-Price]

I appreciate the hon. Gentleman’s point. Perhaps I can reassure him by emphasising that the UK is committed to establishing a far-reaching science and innovation pact with the EU to facilitate the exchange of research and ideas, so we continue to maintain the competitiveness to which he refers.

In bringing forward these proposals, we have been determined to establish our pattern of regulation from outside the EU if need be, but as much as possible we wish to continue with business as usual. We will continue to engage with the sector to maintain competitiveness, because we fully appreciate the value of the life sciences sector to our economy.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Paragraphs 7.6 and 7.7 of the explanatory notes highlight that the EU makes information public and transparent. They talk about the MHRA doing that, but they do not mention that the MHRA would be publishing data within the upcoming EU system.

[Jackie Doyle-Price]

The regulations are determined to facilitate transfer with not only EU bodies, but internationally. We fully recognise that in bringing forward the regulations we are operating in an international landscape. The regulations are designed to facilitate that co-operation, as well as to establish the MHRA as the lead regulator. It is worth noting that, within the current system, the MHRA is the lead. In terms of the regulation we are transposing, rather less is coming to the MHRA given the existing ownership it has in this field.

[John Redwood (Wokingham) (Con)]

Given that our industry is a world leader and a very significant part of the European effort, does the Minister see opportunities in the future for us to have world-class regulation where we lead and differentiate in a way that would strengthen our efforts?

[Jackie Doyle-Price]

My objective this afternoon is to make sure we can continue with business as usual on exiting the European Union, but clearly once we have left the European Union that would be open to us. The ethos behind the regulations and the consultation we have had with the sector very much recognises that this is an international market place. We must ensure that in taking forward these requirements we remain competitive.

As I was saying, we will require the same information requirements as the EU for any new applications for multi-state trials in the UK. There is a requirement that a clinical trial sponsor should be based in the EU. There are a few areas where it has been necessary to add a new requirement, as a result of the UK no longer being part of the European regulatory framework, relating to the MHRA putting in place a new national IT system for safety reporting and submissions. In addition, investigational medicinal products, known as IMPs, imported from the European Economic Area will now require an import licence, as they would no longer be part of the single market. As the hon. Member for Central Ayrshire (Dr Whitford) said, they will be overseen by a qualified person to ensure that the products are appropriately certified. That builds on the existing import licensing system, which allows the transport of IMPs direct from the EEA to UK trial sites to continue. Recognising that this is a new system, we have provided stakeholders with a 12-month transition period from exit day before it comes into force.

While not specifically covered in this statutory instrument, I would like to reassure Members that the Government are engaging with organisations running clinical trials to ensure continuity of supply and that drugs continue to be received. The Government are undertaking a comprehensive deep dive into clinical trial supplies to gain detailed understanding of what is required, and are putting place contingency plans in case the sponsors need them. They will include access to the same prioritised shipping routes that will be available for all other medicines.

As I mentioned in response to the hon. Member for Cambridge (Daniel Zeichner), the Government are committed to ensuring that the UK remains one of the best places in the world for science and innovation. Members should note the Government’s commitment to aligning with the EU’s new clinical trials regulation as far as we can, without delay, when it does come into force, subject to the usual parliamentary approvals.

[Daniel Zeichner]

Will the Minister also comment on the concerns raised by organisations such as Cancer Research UK about future pan-European trials, for which it would appear that the sponsor or lead would have to be from within the EU rather than within the UK?

[Jackie Doyle-Price]

As I said in response to earlier questions, the Government’s approach is that this an international marketplace. We clearly want access to the best possible medicines and to ensure that we can continue to co-operate and share that information as best as possible. I fully expect the MHRA to share that information with the European regulators, as it currently does. Regardless of EU exit, the MHRA and partners across the UK healthcare ecosystem are already taking steps to improve the UK clinical trials application process to ensure that it is as seamless as it can be.

In conclusion, in the event of a no deal, these regulations will put in place a pragmatic solution that ensures that the UK’s clinical trials legislation continues to function effectively after exit day. Essentially, we want this to be business as usual following exit, and I commend this statutory instrument to the House.

--- Later in debate ---

[Jackie Doyle-Price]

I thank all hon. Members who have participated in this debate, which has demonstrated how vital it is that we make sure the legislative underpinning of clinical trials continues safely, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) outlined in her opening comments. That is by far our biggest priority: we need to continue business as usual, and to value our important pharmaceutical and life sciences sector and guarantee people’s safety.

I will try to address some of the points made today. The hon. Lady mentioned the clinical trials regulation and what it would mean in terms of adoption by the UK if it was implemented after March 2019. We expect the clinical trials regulation to be implemented in late 2020, and the MHRA, the National Institute for Health Research and the NHS have been working towards the implementation of that regulation since it was agreed in 2014. The withdrawal agreement Bill will give effect to the implementation period in domestic law and will allow EU regulations to continue to apply directly in the UK for this time-limited period. If the clinical trials regulation comes into force during the implementation period, as it is currently expected to, we would expect to apply that to the UK. If however we leave without a deal—this is why we have these regulations—the CTR will not be in force in the EU at that time so will not be incorporated into UK law on exit day; however, we intend to align, where possible, with the CTR without delay when it does come into force, subject of course to the usual parliamentary approvals. But that alignment will happen after 29 March 2019.

The two key elements of the regulation that are outside the UK’s control and that this instrument does not therefore cover are the use of the shared central IT portal, as mentioned by the hon. Member for Central Ayrshire (Dr Whitford), and participation in the single assessment model, both of which will require negotiated UK-EU agreement regarding UK involvement post-Brexit. This reiterates the wish expressed by the hon. Lady and shared by me that it would be far preferable if we can leave the EU with a deal. Sadly, experience tells us that these things always go to the wire, but let us hope we get a resolution sooner rather than later.

The hon. Lady also mentioned patient safety. Currently a sponsor can report a suspected unexpected serious adverse reaction—SUSAR—during the course of a clinical trial through the EU database. Similarly, all SUSARs originating outside the UK where the sponsor has an ongoing trial in the UK involving the same medical products currently must be entered on the EU database, and we will clearly need to find a way of entering that so we can share such information and have arrangements for holding it on the MHRA database.

[Dr Whitford]

Does that mean that that ability is not there if the UK leaves without a deal, for April of this year?

[Jackie Doyle-Price]

Being brutally honest with the hon. Lady, and perhaps more honest than some are in this debate, I do not think we can dictate terms to our EU partners; I think we can look forward to having constructive working arrangements with them and it is in all our interests to do so, but ultimately we would have to seek agreement about this. At this stage this SI can only really cover the things that are in the gift of this Government, and a lot will rest on good co-operation after the event, which again means it would be much more preferable to leave with a deal.

[John Redwood]

Given the great importance of joint venture companies and joint investment and joint activity across the Atlantic, will the Government also be looking at changes in American regulation to see if any of that would be appropriate—or maybe a UK version could be better than both the American and EU ones?

[Jackie Doyle-Price]

My purpose this afternoon is to ensure that we have business as usual post-exit day, and that we can maintain patient safety at that time. I would not want to encroach on any debate beyond that now.

Questions were raised regarding research funding. I should advise the House that before the Brexit vote the UK was involved in more EU-funded science projects than any other country. The UK secured 14.3% of the total share of the funding to date and is the second-highest recipient of grant funding. We are committed to remaining a world leader in science and research, and that is why, in our modern industrial strategy, we have committed to spending 2.5% of our GDP on research and development by 2027. We have invested an extra £7 billion in research and development as a first step towards that.

[Henry Smith (Crawley) (Con)]

My hon. Friend has said that just over 14% was received by this country from EU funds. Does she have the figures to hand—I would not blame her if she did not—for the percentage of funds that we gave to the EU to be distributed around the bloc?

[Jackie Doyle-Price]

I do not have a detailed knowledge of the accounts in that regard. I can only tell the House how much we have received, and how we are replacing it, which is really the crux of the matter.

Mention was also made of what the Government are doing to prevent the loss of EU nationals working in research. We have been clear that we wish the UK to continue to be an open and tolerant nation, and to continue to attract the brightest and the best. That is equally applicable here. The Prime Minister told the House of Commons on 21 January:

“Having listened to concerns”

about the settled status scheme

“I can confirm today that, when we roll out the scheme…the Government will waive the application fee”.—[Official Report, 21 January 2019; Vol. 653, c. 27.]

We want to give a clear message that we are open for business and open to the brightest and the best.

In bringing these regulations to the House, the central point is that the fundamentals of how clinical trials operate will remain the same and that, wherever possible, we have sought to maintain existing arrangements rather than creating new ones. While it is not the focus of this statutory instrument, the Government are working to ensure that the trials have continuity of supply and will continue as planned. I commend these orders to the House.

Question put and agreed to.

Resolved,

That the draft Medicines for Human Use (Clinical Trials) (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 23 January, be approved.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 19th February 2019 Commons Chamber

[Christine Jardine (Edinburgh West) (LD)]

3. What assessment he has made of the effect of toxic air on children’s health.

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

Poor air quality is the largest environmental risk to public health in the United Kingdom. Long-term exposure to air pollution can cause chronic conditions, such as cardiovascular and respiratory diseases, as well as lung cancer, leading to reduced life expectancy. It has a particular impact on children as they grow. There is evidence to suggest that the process of normal lung function growth in children is suppressed by long-term exposure to air pollution.

[Christine Jardine]

In Edinburgh West we have two of Scotland’s most polluted roads, St John’s Road and Queensferry Road, according to recent figures. Studies show that if someone lives with 75 metres of any major road as a child, they have a 29% increased risk of lifetime asthma. Given that across the country there are 2,000 nurseries close to roads with dangerously high levels of pollution, what action can the Minister assure us is being taken, along with counterparts in Scotland and in the Department for Environment, Food and Rural Affairs, to tackle this on a UK scale?

[Jackie Doyle-Price]

The hon. Lady will be aware that we have a clean air strategy, which, as she rightly says, is led by my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs. We have a number of measures designed to improve air quality, such as reducing all pollutants, getting more diesel and petrol cars off the roads, and tackling wood-burning fires. We also need to be much more vigilant in advising the public about the risks, and that includes on how they use their cars. Time was when I went to school we used to walk, but too often we see parents dropping off their kids with idling engines, and that causes pollution.

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

The Minister is very good at warm words. Why does she not talk to the Secretary of State for Environment, Food and Rural Affairs, because his Department’s plan is to tackle the poisonous air that our children and pregnant women are breathing by 2040? The fact is that children are being poisoned now. Get on and do something about it.

[Jackie Doyle-Price]

To be frank, I am not often accused of using warm words, but I will take the compliment. I can assure the hon. Gentleman that we are working very closely with DEFRA, but ultimately we need to encourage the public to change their behaviour, and we need to have a much more open debate about the consequences of bad air.

[Several hon. Members rose—]

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

Will the Minister join me in welcoming the work of UK researchers to develop a new protocol for managing asthma, such as a pill to reduce the number of attacks by targeting airway muscles, developed in partnership with researchers in Canada?

[Jackie Doyle-Price]

I will always welcome any research designed to improve the treatment of asthma. Certainly, from a public health perspective, we must do much more to prevent asthma and reduce the likelihood of life-threatening attacks.

[Craig Mackinlay (South Thanet) (Con)]

4. What steps the Government are taking to improve mental health service provision.

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

Under the NHS long-term plan, there will be a comprehensive expansion of mental health services, with at least an additional £2.3 billion in real terms by 2023-24. That builds on our ambitious targets for improving community and crisis care, with extra treatment for 370,000 adults per year, and for 345,000 children and young people by 2023.

[Mr Speaker]

Yes, but I think that the Minister is seeking to group this question with that of the hon. Member for Ochil and South Perthshire (Luke Graham). Am I right?

[Jackie Doyle-Price]

Yes, indeed. My apologies Mr Speaker.

[Mr Speaker]

I would not want the hon. Gentleman to feel any sense of social exclusion.

[Craig Mackinlay]

One of my constituents, Mark Verrion, is a patient of Kent and Medway NHS and Social Care Partnership Trust. He was first admitted on a temporary basis following an unfortunate but mild episode. He has now been institutionalised for 11 years, and he has been moved over 100 times during that period, often out of area. The trust has 289 out-of-area placements for adult mental health services, which is an increase of 100 over the past year, and the cost to local health budgets is obvious. Does my hon. Friend agree that my constituent and all the other out-of-area patients deserve local health provision to enable them to remain within the trust area?

[Jackie Doyle-Price]

I quite agree with my hon. Friend. Frankly, I am horrified to hear the account he has just given. We have made a priority of getting rid of out-of-area placements, because we know that patients do better when they are among family and friends. Clearly the case he has just outlined, which has lasted the past 11 years, is totally unacceptable. I will give it my personal attention and meet him to discuss it.

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

6. What UK-wide steps is my hon. Friend taking to ensure that Scotland is not left behind in mental health provision, especially given that only two thirds of young people are referred within the 18-week timeline, against a 90% target?

[Jackie Doyle-Price]

As my hon. Friend knows, health is a devolved matter, but I am keen to share best practice with colleagues in Scotland, who face many similar challenges. In England, we will test four-week waiting times for access to NHS support in the community and we are committed to sharing that expertise, as we often do, with colleagues in Scotland.

[Eleanor Smith (Wolverhampton South West) (Lab)]

In the Government’s 10-year plan for the NHS, a growing share of the budget is promised for improving mental health services in the coming years. The mental health services in Wolverhampton are in a desperate state of underfunding now. I am receiving letters from my constituents telling me how they have to wait over a year or more to be treated. One woman told me:

“I personally know people who have attempted to take their own lives, thankfully unsuccessfully… but… aftercare once discharged from hospital”

is non-existent. When will people see the benefits of the 10-year plan? By the time the uplift takes place, it will be too late for some of them.

[Jackie Doyle-Price]

As we outlined in the 10-year plan, we fully recognise that there needs to be much more investment in community and crisis care, including direct access via the 111 service. By April, we will be able to put more flesh on the detail of how we will roll that out. I assure the hon. Lady that I am in no way complacent about the challenges we face in ensuring that our mental health services are what people should expect of them.

[Paula Sherriff (Dewsbury) (Lab)]

Last week, The Guardian revealed that hospital admissions for eating disorders have surged in the last year. Meanwhile, the number of children and young people with urgent cases of eating disorders who are treated within a week has fallen, and the number of those waiting between one and four weeks has risen. If prevention is better than cure, why do so many children and adolescents with eating disorders end up in A&E?

[Jackie Doyle-Price]

The hon. Lady is right in the sense that we have waiting targets for eating disorders, whereby the most acute cases should be seen within a week. We have seen very good progress—indeed, in most areas those targets are met. I will look into the cases that she has highlighted because we need to give attention to where the targets start to be missed. However, I assure her that we recognise that tackling eating disorders among our youngest people through early intervention must be done because prevention is always better than cure.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

On Friday, I joined the brilliant A&E team at the James Cook University Hospital in Middlesbrough for a night, and it was an insight into just how lucky we are to have our NHS staff—they are fantastic. On the subject of mental health, one of the key themes that recurred in the night was the problem of drug addiction and its impact on A&E pressures. What action will the Minister take in the long-term NHS plan to ensure that we can tackle addiction?

[Jackie Doyle-Price]

We are aware that substance misuse and addiction have a massive impact on mental health. Again, I point to the fact that we have objectives in the long-term plan, including joining up more effectively with local authorities’ work on mental health. Tackling addiction and substance abuse is very much a priority.

[Mr Gregory Campbell (East Londonderry) (DUP)]

The Minister will be aware of the high prevalence of mental health issues among ex-service personnel, particularly people who served in Northern Ireland and the middle east. What provision is she making for those who suffer unduly on the mental health front?

[Jackie Doyle-Price]

I am grateful to the hon. Gentleman for raising the matter. Through the military covenant, we have an absolute duty to provide the best possible care to those who have made that commitment to service on our behalf. Through NHS England’s commissioning of specialised services, we are determined to ensure that we have the right provision for all our veterans and servicemen. I am in contact with the Ministry of Defence to ensure that we do all we can for them.

[Martin Vickers (Cleethorpes) (Con)]

5. What steps he is taking to improve the provision of care and support to children and their families in children’s hospices.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

12. What steps his Department is taking to improve survival rates from sudden cardiac arrest.

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

NHS England announced in the NHS long-term plan that it would work with partners to improve the community first response and build defibrillator networks to improve survival rates for out-of-hospital cardiac arrests. A national network of community first responders and defibrillators will help to save up to 4,000 lives each year by 2028. This will be supported by educating the general public, including young people of school age, about how to recognise and respond to out-of-hospital cardiac arrests.

[Maria Caulfield]

I thank the Minister for her response. Currently, 12 young people a week die from a sudden cardiac arrest, but 80% could be saved if those around them had access to a defibrillator. Will the Minister consider supporting the installation of defibrillators in all schools in England and Wales?

[Jackie Doyle-Price]

My hon. Friend is right to highlight the 12 deaths from sudden cardiac arrest in the young. Although the purchasing of a defibrillator is a matter for individual schools, the Government would encourage schools to buy them. The NHS supply chain is engaging with school networks to get good prices for these defibrillators, and the Department for Education has published on the Government website guidance for schools on buying and installing an automated external defibrillator. In addition, in January, the DFE announced plans for all children to be taught basic first aid in schools, including how to do CPR and use a defibrillator.

[Alison McGovern (Wirral South) (Lab)]

13. What steps his Department is taking to reduce waiting times for mental health patients in the north-west.

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

National waiting time standards for early intervention in psychosis, improved access to psychological therapies and services for children and young people with eating disorders are already being met, or are on track to be met by 2020-21, in the north-west. We will introduce new waiting times and targets under the NHS long-term plan, and we have an ambition to deliver many more treatments for all who need them.

[Alison McGovern]

Adult waiting times in Wirral for talking therapies to treat anxiety and depression are some of the worst in the country. The average waiting time between referral and first treatment is 48 days, and between referral and second treatment, when we know that someone needs help, it is 159 days. Will the Minister thank all the volunteers in Wirral who are trying to help those who are suffering from anxiety and depression, and will she explain to me what she is going to do to stop this crisis?

[Jackie Doyle-Price]

First, I certainly thank all the volunteers who do so much to support people in mental ill health. It is worth emphasising the role of the voluntary sector in that regard, and I encourage clinical commissioning groups to consider commissioning additional services form the sector, because so much of that wraparound care is as important as clinical intervention to repairing mental health.

There have been problems with the improving access to psychological therapies programme and with recovery targets in the past. The Wirral CCG has told me that the backlog of more than 1,000 patients has been cleared after it provided additional funds and that the IAPT targets are now being met, but obviously I will keep the position under review, and I thank the hon. Lady for raising the issue.

[Robert Halfon (Harlow) (Con)]

14. What plans he has to allocate additional funding to NHS hospitals to replace revenue raised by car parking charges.

--- Later in debate ---

[Stephen Timms (East Ham) (Lab)]

T9. The Central and East London breast screening service was performing well until last April, when it was transferred from Barts Health NHS Trust to the Royal Free London NHS Foundation Trust, even though the Royal Free and did not have enough staff. The number of women invited plummeted from 3,000 a month to 1,000 a month. Why was that transfer allowed to go ahead, given the clear warnings about what the consequences would be? Who is responsible for this failure?

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

The award of the contract for the Central and East London screening service to the Royal Free was approved by both NHS England’s London region and NHS England’s commercial executive group. An agreed recovery plan was put into place to address the various issues. While the service did plummet to 1,100 in April 2018, it is currently inviting 3,000 women per month, which has been the normal monthly invitation rate for the service for the past three years. Women are currently being offered appointments in line with the agreed recovery plan and with the national breast screening standard, with 90% or more being invited within 36 months of their previous screening by October 2019.

[Paul Masterton (East Renfrewshire) (Con)]

The internet and social media have provided huge opportunities and positives for our young people, but we have been far too slow to react to the negatives, including cyber-bullying and issues around body image. Will the Minister responsible for suicide prevention, or my right hon. Friend the Secretary of State, confirm that they are taking a truly cross-Government approach to this issue and that they will seriously tackle the role of the tech companies?

[Bill Esterson (Sefton Central) (Lab)]

The greatest damage from prenatal exposure to alcohol is often done in the first few weeks of pregnancy, yet three quarters of women in the recent Bristol University study said that they drank alcohol while pregnant. Will the Minister commit to ensuring that the chief medical officer’s advice is given loud and clear by all health professionals: do not drink alcohol if pregnant or trying to conceive?

[Jackie Doyle-Price]

I am pleased that the hon. Gentleman has raised this important point. We need to deliver this important public message because, as he rightly observes, the damage caused by alcohol can take place in the earliest part of pregnancy. Anyone seeking to get pregnant should be monitoring their alcohol intake, and in fact withdrawing altogether. It is important that we make the public aware of this, not least because of the rate of unplanned pregnancies, which continues to rise.

[Royston Smith (Southampton, Itchen) (Con)]

Southampton is above the English average with nearly 6% of GP appointments being missed. Nationally, missed appointments cost the NHS more than £200 million a year. Does my right hon. Friend agree that a standardised online booking system featuring a reminder function with the option of cancelling or rescheduling an appointment would save money and reduce waiting times? Does he have any plans for such a system?

[Louise Haigh (Sheffield, Heeley) (Lab)]

A recent answer to a parliamentary question from my hon. Friend the shadow Minister confirmed that in nearly half of cases of mental health crisis, it is not NHS staff but the police who are conveying people hospitals. Will the Department conduct a review into the impact that this is having on people in mental health crisis?

[Jackie Doyle-Price]

The hon. Lady raises an important point. This is something that I am taking forward with the Minister for Policing and the Fire Service. We are acutely aware of the impact that this is having on policing services, and that is one of the reasons why, in the forward plan, we have directed so much support and priority to ensuring that the NHS 111 service works and that we have the community and crisis care services to back it up.

[David Tredinnick (Bosworth) (Con)]

A report in The Lancet in March 2018 found that most drugs and injections are useless for lower back pain. What will my right hon. Friend do to find alternative treatments?

Licensing of Medical Devices

Jackie Doyle-Price Excerpts

Tuesday 12th February 2019 Commons Chamber

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

I congratulate the hon. Member for Pontypridd (Owen Smith) on securing this debate and again challenging me on the regulation of medical devices. Obviously, we have discussed issues relating to mesh before, but this evening he has given a comprehensive critique of the weaknesses in the regulation of medical devices. We have to be very conscious that, unlike drugs, once a medical device is implanted, it stays there for good; the body does not process it and it does not leave the body. We can, therefore, imagine that clinical evidence and trial evidence will take many years to build up. Our perspective, from the point of view of trying to guarantee patient safety, needs to consider that in any future method of regulation.

The hon. Gentleman has highlighted some of the weaknesses. It is fair to say that perhaps in the past regulation has focused excessively on what is in the commercial interests of businesses to maintain competition, rather than having patient safety at its heart; I think that, when it comes to medical regulation, it should have that at its heart. Naturally, he referred to mesh, which he and I have discussed many times before. There is no doubt that mesh has transformed the lives of some women when they were living with the debilitating consequences of stress incontinence, but it is becoming clear that mesh was deployed far too insensibly—far too many women were given this treatment, often at comparatively young ages, given that this was going to stay in their body for a long time.

I do not want to pre-empt what will come out of the Cumberlege review, but I have discussed some of the findings with Baroness Cumberlege. On the whole issue of how our medical establishment have dealt with this, the conversations that have taken place with women who were having this treatment were utterly inadequate and we will learn many lessons. I say to those women who have suffered badly at the hands of mesh treatment that there are clear medical criteria relating to that product and, if they have any complaint about the treatment they have received, they should be pursuing claims for clinical negligence against their practitioners. We look forward to the conclusions of Baroness Cumberlege’s review.

The hon. Gentleman and the right hon. Member for Cynon Valley (Ann Clwyd) mentioned the issue of the national devices registry. I will say, up front, that I can assure them that this matter is already under consideration by the Department and it is linked to our wider digitisation agenda for the NHS. We have the technology and we should use it, in the interests of patient safety. We will be implementing that under new EU regulations to trace medical devices through unique device identifiers. I would be more than happy to meet him at a later date as we progress these proposals. As we depart from the European Union, we have an opportunity to alter our regulatory system. I am not sure that all my Conservative colleagues, in pushing Brexit, see it as an opportunity to tighten regulation, but that opportunity remains, so I look forward to that dialogue.

We clearly need to improve the existing system of regulation. As the hon. Gentleman mentioned, the EU directive currently under consideration will deliver that improvement, and we fully intend to take that forward. As he has described, medical devices are regulated in an entirely different way from medicines, and we need to make sure that regulation remains fit for purpose and that it responds to technological innovation. We also need to make sure that we have sufficient pre-market assessment, so that in assessing their efficacy we can really give evidence of how these devices are used by patients. That is why manufacturers, notified bodies and the MHRA conduct ongoing post-market surveillance. We will all wish to be made more confident that that is fleet of foot where it identifies any potential weakness. The more data we can collect, the more we can make those judgments earlier. The emergence of a better registry will enable us to do exactly that. I acknowledge wholeheartedly that there is scope for improvement and that systems and processes need to be constantly tested against the ultimate purpose—that guiding star, the principle of patient safety. No patient who presents themselves to any area of the national health service should expect anything other than the best possible care. They should be able to trust that we have in place a regulatory regime that will protect them. I am personally committed to that review and challenge.

As I mentioned, we will implement the regulatory improvements currently being taken through the EU, even though we are now leaving the EU institutions. We are confident that the regulation will drive system-wide improvement, including to the levels of clinical data mandated before products can be placed on the market. That will establish a strong and improved baseline for any system we implement after our departure from the EU. These changes to our system will place more stringent requirements on those manufacturing and supplying medical devices and will enhance the MHRA’s market surveillance responsibilities, resulting in clearer obligations to conduct inspections and the ongoing safety monitoring of devices.

In advance of those new regulations, the Government have taken a number of actions to ensure that existing legislation is operating as effectively as possible. That includes a programme of joint assessments of notified bodies, including inspections by multiple competent authorities to ensure that notified bodies’ assessments of new products and robust implementation of new standards for the clinical data are required for the new high-risk devices coming to the market.

It is true, I have to confess, that there has been a historic lack of transparency in the current system. It has not always been easy for patients to investigate and find more data about the things being put in their bodies. That is why the Government have prioritised the issue in negotiations on the new EU legislation. When those changes are implemented, there will, as the hon. Gentleman said, be an EU database that will contain details of all devices on the UK market, including where safety issues are identified. We are committed to ensuring that that will happen as part of our planning for a no-deal exit from the European Union.

Before I run out of time, I again want to mention the Cumberlege review, which will report later this year. It will give us many lessons about just how our medical device regulation has been less than optimal in the past. We will of course commit ourselves to any changes to respond to that review. I thank the hon. Gentleman for securing this debate and I look forward to further debate with him on these issues.

Question put and agreed to.

Non-surgical Cosmetic Procedures: Regulation

Jackie Doyle-Price Excerpts

Tuesday 12th February 2019 Westminster Hall

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

I thank my hon. Friend the Member for South Leicestershire (Alberto Costa) for introducing this extremely timely debate. It is good to see so many colleagues showing an interest. I am delighted to see my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who made a start on regulating what is a growing industry. These days, we are all concerned about our body image. We all want to look good, and the industry has grown very rapidly. However, it is important to ensure that the public understand the risks associated with the procedures, and we need to do our best to improve standards throughout the industry.

[Judith Cummins (Bradford South) (Lab)]

Does the Minister agree that as well as looking at regulation we need to celebrate the beauty industry, which is led predominantly by women, predominantly employs women, and contributes hundreds of millions of pounds to our economy?

[Jackie Doyle-Price]

I am happy to endorse that point. It is worth bearing in mind that in wishing to regulate the sector we do not want to undermine its dynamism and competitiveness. What we really need is to ensure that consumers are properly educated, so that they can make informed choices about where they seek treatment and can protect themselves. Medical professionals are equipped to deliver some of the treatments, but we do not necessarily want that as a monopoly. Provided we have an appropriate system of regulation with everyone signing up to the same expected standards, such a system can be embraced.

We have had reference to Sir Bruce Keogh’s invaluable review, led by my hon. Friend the Member for Central Suffolk and North Ipswich. The Government have acted to improve the regulation and registration of those performing cosmetic interventions, but we clearly need to make much more rapid and substantial progress if we are to protect consumers properly. The industry is ever-expanding. We have heard that treatments are now available on the high street in places such as Superdrug, but this is not like going to have a haircut. When things are injected into a person’s face, if it goes wrong, it takes a lot longer to fix than letting their hair grow again would. We need to be sure that we are properly looking after consumers, including their safety.

[Dr Poulter]

I welcome what the Minister has said about wanting to go further with regulation. Historically, the challenge has been other Government Departments pushing back against the position of the Department of Health, which has wanted to protect people—seeing them as not just consumers but people who would be considered as patients in other capacities—and put in place adequate regulation of this sector. I hope that, given the Minister’s interest in this topic, she will be able to take the challenge to other Government Departments, and overcome the out-and-out free-market instincts that are putting people at risk.

[Jackie Doyle-Price]

I could not agree more with my hon. Friend. He is absolutely right: the priority for us in the Department of Health and Social Care has to be the safety of people undergoing these procedures. Aligned with that, I was pleased to see in the challenge to Superdrug a recognition of the fact that people’s seeking these sorts of treatments can be an indication of dysmorphia and an underlying problem. We need to make sure that all practitioners in this field have the ability to recognise those problems.

[Liz McInnes]

I also wanted to raise the issue of dysmorphia, which strays into the area of mental health. I am concerned that we seem to be accepting that it is okay for people to want to change their appearance. The issue of body dysmorphia illustrates that people may be asking for these procedures for the wrong reasons, and I question whether somebody on the high street who is not a qualified mental health practitioner is able to determine whether somebody is suffering from body dysmorphia.

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Lady goes to the nub of this issue. We need to achieve an appropriate balance between allowing consumers to choose to embark on procedures that will enhance their appearance, and identifying whether the issue is something deeper. Again, it comes down to how we regulate those practitioners, the codes of conduct that they will sign up to, and the policies that they will put in place themselves. To an extent, the hon. Lady is right: dysmorphia can only be diagnosed by a medical professional. However, there are signs that can be taken into account, that can lead to the person’s being asked, “Do you really want to do this? Is this an appropriate procedure for you?” Perhaps there should be cooling-off periods, with bookings being made properly, and customers being advised about the risks that such treatments involve, so that they can make an informed choice. The hon. Lady is right to highlight the growing issue of dysmorphia, which we need to be very alive to.

[Melanie Onn]

This is a really important point. Even in the realm of plastic surgery, which is a regulated industry, we see grotesque transformations of people’s bodies and faces: people having ribs removed, leaving their external organs exposed, or having their entire appearance amended to make them look like a human Ken doll. We know that regulation in that sector is not really working, so can we make sure that in the currently unregulated sector of Botox injections and dermal fillers, we keep a closer eye on such things?

[Jackie Doyle-Price]

The hon. Lady makes an extremely good point. The worst thing is that the media representation of those quite grotesque transformations encourages us to look on them as entertainment, yet the person we are looking at has no idea, because those transformations are symptomatic of dysmorphia. The media have to be a lot more sensible about their portrayal of these things. My hon. Friend the Member for South Leicestershire mentioned the adverts during “Love Island”; these artificially enhanced images of people are becoming entertainment. I am delighted that in this country we have banned the Brazilian butt lift, which aims to make people look like one of our friends the Kardashians, but even so, people still aspire to look like that.

We can discuss regulation and ensuring that consumers understand the risks, but there is a wider challenge to society in how we celebrate learning to love ourselves. We have talked generally about the pressure that social media creates, which is becoming much more intense, but there is a hell of a lot more to do. Sadly, we could probably debate this issue for quite some time—we do not have the opportunity to do so today—but the debate about cosmetic regulation and making cosmetic procedures safe brings out these questions, which we as a society need to be better at addressing. If we do not address them, these issues about dysmorphia will only get worse, because our young people are faced with an intensity of images that make them want to change their bodies. It is just not good for them.

As there is limited time left, I will bring hon. Members up to date about what has happened since the Keogh review. Sir Bruce Keogh’s report identified several areas for change: the principles that underlined it were those of high-quality care, using safe products, administered by skilled professionals and responsible providers to an informed and empowered public. We still have a long way to go in both empowering the public and ensuring that all such procedures are administered by skilled practitioners. I wholly endorse the demand by my hon. Friend the Member for South Leicestershire that such practitioners should have professional indemnity insurance. It is important that the NHS has the opportunity to recover the costs of repairing procedures carried out by those practitioners, who should bear the risks. As I say, this is not like going to the hairdresser’s for a haircut: there are risks associated with such procedures, and those engaged in them should bear those risks.

Updated guidance for doctors about this area has been issued by both the General Medical Council and the Royal College of Surgeons. We have introduced a voluntary certification scheme for surgeons working in the cosmetic sector, and Health Education England is developing a training and qualification framework for providers of non-surgical interventions. A key outcome of the Keogh review was setting standards that anyone who wishes to perform non-surgical cosmetic procedures should meet. To that end, the Joint Council for Cosmetic Practitioners was established, and in April 2018 it launched a register for both medical and non-clinical cosmetic practitioners. That register will provide a framework for regulation, but we need to do much more to encourage non-clinical cosmetic practitioners to sign up to it.

Alongside the Cosmetic Practice Standards Authority, the JCCP released an updated competency framework last September, and launched its education and training register. To receive accreditation on that register, providers offering education and training in these procedures must meet rigorous standards set by the JCCP. We need to work closely with the JCCP to develop hallmarks that people who wish to undergo these procedures can look for, so that they can be sure that they are obtaining treatment from a regulated practitioner. We have heard references to Save Face, which also holds a register for clinical cosmetic practitioners who provide non-surgical cosmetic treatments. Some 600 practitioners are currently covered by these registers, but I am sure that hon. Members from across the House will appreciate that significantly more than 600 practitioners offer these treatments. There is some way to go in ensuring that all those involved in this industry perform to the standards that we can legitimately expect, and that those who are not doing so exit the industry. However, I am sure that my hon. Friend the Member for South Leicestershire will agree that those registers are major steps forward in enabling consumers to make informed choices about cosmetic procedures.

I am grateful to my hon. Friend’s constituent for coming forward and telling her story, because probably the best way of helping consumers protect themselves is to have a visual illustration of the risks and someone who can demonstrate their experience. I am very grateful to her for her courage in sharing her story. We need to do much more in the area of public education, to ensure that consumers fully appreciate that there are risks involved in injecting substances into one’s face, and to ensure that the person doing so has appropriate qualifications. Botox is obviously a prescription drug, but the person injecting it does not have to be the person who obtained the prescription. That is another thing that we need to address. I can also advise my hon. Friend that we will be making dermal fillers a regulated medical device, which will remove some of the risks associated with them. However, as I have said, there is plenty more to do.

Motion lapsed (Standing Order No. 10(6)).

Community and Voluntary Services: Derbyshire

Jackie Doyle-Price Excerpts

Friday 8th February 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 bringing forward this important matter for debate.

First and foremost, I would like to reiterate the vital role that the voluntary sector plays in ensuring that people have access to the services that they need in the places where they live. Indeed, I go much further: I am an extremely firm advocate of encouraging NHS commissioners to commission services from the voluntary sector to get much better coverage nearer people’s homes and achieve better outcomes for patients at good value for money. I defer to no one in my support for the voluntary sector. The principle of making use of and commissioning services from the voluntary sector is a key theme in the long-term plan, and we will be investing at least an extra £4.5 billion a year in primary care and community health services.

This is the first time in the history of the NHS that real-terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall. Clearly, that is not reflected in the comments that the hon. Lady has just made. I understand her concerns about the cuts in funding for services in Derbyshire. I am advised by the CCG that it has confined the cuts to those services that are not associated with delivery of their statutory services and that of a potential £1.25 million that was earmarked as meeting those criteria, only £300,000 has been cut. It is worth putting into context why that is.

Clearly, the Derbyshire CCGs have a duty to ensure the long-term sustainability of health services in the area. In the light of well-known financial challenges, that CCG has had to make difficult decisions on where to prioritise funding. As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that local areas are not running at a deficit. This is absolutely essential if we are to have an NHS that is financially sound and sustainable in the long term. Owing to their financial position, all Derbyshire CCGs are required to scrutinise their financial spend to ensure the best outcomes for patients for the investment made and to deliver financial balance. They have been working on that in close collaboration with NHS England. The joint saving plan agreed with NHS England states that if the CCGs make savings of £51 million, the remaining £44 million will be absorbed by NHS England. It is very much a joint approach to tackling the financial position in which the Derbyshire CCGs find themselves. None the less, they need to live within their means, and that is why they have had to review the overall spend and identify where savings can be made. It is challenging, but I have been assured that the absolute top priority of the CCGs is to minimise the impact that cuts have on patients.

I listened with sympathy to some of the points the hon. Lady made about spending on services provided by the voluntary sector that keep patients out of hospital and support them to live independently, and clearly I want to encourage all CCGs to commission exactly those services. I am reassured that those services that continue to be funded by CCGs, rather than remaining with grants, have been issued with NHS commissioned contracts—that has been done for stroke support, eating disorder and bereavement services—and I am satisfied with the efforts of CCGs in that area.

[Ruth George]

The Minister says that the cuts are to services that do not deliver such good statutory support. How does she think that community transport does not deliver for patients struggling to get to, say, follow-up appointments for bowel screening?

[Jackie Doyle-Price]

The advice I received from the CCGs was that they had reduced grants only for services not part of their statutory functions, which fall to other agencies, particularly local authorities, with which they are working closely to make alternative funding available for some of the organisations that have been cut. I cannot answer the hon. Lady’s specific question about transport, but I understand that the total cut to transport amounts to £24,000 out of £300,000, so we are talking about quite a small part of what have been significant savings of £44 million that the CCGs have had to find. Support for local transport and accessibility normally falls to local authorities.

The voluntary and community sector has been an important part of the health system for many years, and partnership working between the voluntary sector, local government and the NHS is crucial to improving care for people in their communities. I expect all local CCGs to build much stronger relationships with local authorities to better join up all support services for patients. I welcome the scrutiny of this process by the health overview and scrutiny committees. I appreciate that it has been extremely political, but it is important that those decisions be taken transparently.

We also recognise the important role the community can play in helping people to maintain their health and wellbeing. Social prescribing is crucial. We are encouraging CCGs to look much more at such solutions, and not just at the medicalised solutions, and we will be using part of the £4.5 billion investment set out in the long-term plan to recruit more than 1,000 social prescribing link workers. I hope they will be able to work with the voluntary sector in the hon. Lady’s constituency.

We will also be looking at funding expanded community multi-disciplinary teams, meaning that in five years all parts of the country will have improved the responsiveness of their community health response services to deliver crisis services within two hours and reablement care within two days.

I appreciate that it will always be difficult to tackle a financial deficit of the size of that of the Derbyshire CCGs, and I welcome hon. Lady’s engagement in that process and the public scrutiny. I also pay tribute to the work of my hon. Friend the Member for Erewash (Maggie Throup), who has been representing the concerns of her constituents in this respect. I am assured and satisfied, however, that the Derbyshire CCGs have done the best they can to support funding for the voluntary sector where it has been delivering a valuable service to the rest of the health sector. Indeed, one of the overriding criteria for making decisions regarding these cuts was that it would not lead to additional demand on health services and additional spending elsewhere, and I am satisfied that the decisions have been taken on that basis.

[Ruth George]

The GPs on the CCG themselves stood up in the meeting and said there was a recognised risk that these service cuts would create cost pressures on other areas of services, so I am sorry, Minister, but it is simply not guaranteed at best, very likely at worst.

[Jackie Doyle-Price]

I say respectfully that we expect the CCGs working with NHS England to properly interrogate the implications of their decisions, and they have done that; I have been given that advice, and I stand by the advice I have received from them on that.

I recognise, however, that those local commissioners in Derbyshire have had to make very difficult decisions, and we do believe that they are best placed to make those decisions. They have access to the local expertise and clinical knowledge needed to make an informed decision.

While I recognise the hon. Lady’s concerns, I hope she can reassure her constituents that the local CCGs are working to provide sustainable services that meet the needs of the people living in Derbyshire. The Government will continue to work with the local CCGs and NHS England to help progress with ongoing work and to help create those sustainable services for the future.

Question put and agreed to.

Early Parenthood: Supporting Fathers

Jackie Doyle-Price Excerpts

Wednesday 30th January 2019 Westminster Hall

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

I have enjoyed listening to everyone’s contributions this morning. It is often said that MPs do not live in the real world, but we have heard some frank accounts this morning that very much prove that we do; we do share those experiences. I am proud of my hon. Friends who have been raw in their accounts of fatherhood. I hope that my hon. Friend the Member for Moray (Douglas Ross) has not been put off by any of the things he has heard today.

The tone for the honest and frank accounts was set by the opening comments by my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who was characteristically honest in her expositions. I am grateful to her for obtaining this debate. It is time that we gave a big shout-out to dads.

The hon. Member for Ealing Central and Acton (Dr Huq), who is no longer in her place, mentioned the 400,000 single-parent families headed by dads. My partner was one of those 400,000; he raised his son alone for the first 10 years of his son’s life. It is often challenging for single dads, as things are focused on the mums. When he first started taking George to primary school, he was viewed as a bit of a curiosity by the mums and the teachers. A lot of low-level discrimination takes place towards dads in those circumstances, which we ought to be more alive to. That is probably symptomatic of discrimination towards dads. We have heard frankly today that it is all about the mum and the baby, and that the dad is a spare part. My hon. Friend the Member for East Renfrewshire (Paul Masterton) described driving home, having gone through the trauma of childbirth, and asking, “What happens now?”, then not being able to visit mum the next morning. Collectively, society needs to be a lot more understanding and welcoming of the father’s role in those early days, weeks and months, not least because it gives children the best possible start in life if dad is fully engaged.

We know that now, more than ever. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) is my conscience on these issues. He constantly emphasises to me that good-quality relationships are critical for every member of the family. He is absolutely right. Where society can bolster that, obviously we should take those steps. He has highlighted some things for me to look at, and I assure him that I will.

Childbirth and parenthood is life-changing and my hon. Friends have shared their experiences to illuminate that. Having support from a father as well as a mother is extremely important. We know that there are very real barriers to that involvement, including the pressures of work, which a number of colleagues have alluded to, particularly where employers in particular fields of employment are less than understanding about the fact that family is dad’s work as well as mum’s. That is something that we need to tackle. We have mentioned that services are not always tailored to dad’s needs as well as those of mums.

There is a general lack of information. A life-changing thing happens, and people are kind of expected just to suck it up and go along with it. It can be extremely challenging and scary, so we need to be more understanding of that. We also need to be cognisant of the fact that it is the time of most acute stress and strain on relationships. It is probably the riskiest time for relationship breakdown. We need to make sure that wraparound support is available to dads who need it.

I would like to say that I was satisfied with progress. It is true that progress is being made, but the debate, and the research that has been mentioned, show that we need to do more. Among the things that we are putting in place and expect to deliver, our first steps clearly need to be in maternity services. We believe that they should do more to maximise fathers’ involvement, at a time that clearly offers the most important opportunity to engage them in the care of their partner and the upbringing of their children. I can tell my hon. Friends who did not have that experience that we have invested £37 million to support the involvement of fathers in labour and post-natal units, including en suite rooms and double beds adjacent to maternity wards. Clearly, that would be a much better experience for new fathers, and we will make sure that that arrangement is rolled out more and more. National Institute for Health and Care Excellence guidance states that women, their partners and their families should always be treated with kindness, respect and dignity. We need to make sure that that is done properly. Scrutiny will be through Care Quality Commission inspections, which will be designed to ensure that maternity services deliver what we expect.

Interestingly, according to CQC’s survey of women’s experience of maternity care, 96% of women said that their partner was able to be involved as much as they wanted during labour and birth. Clearly that is not consistent with the figures that we heard today, but the explanation is probably that the question was asked of mums rather than dads. It illustrates what has been said about feeling like a spare part. My hon. Friends have been honest about their emotions at the time in question, and we know that men are not always frank in exposing their emotions. What the survey tells me is that a mum does not always know that the dad feels completely useless and like a spare part. That tells us that we have an issue to tackle. Seventy-one per cent. of women said that their partner or companion was able to stay in hospital with them as much as they wanted, but that is not borne out by the feedback today. My message going out to the health services is that in addition to inspections and standards there needs to be much more sensitivity and leadership, to make sure that dads are properly considered during such an important period.

I constantly challenge the instinctive prejudice within the system to spend the considerable amount of resource that the Government make available to the NHS on clinicians and clinical support, when we know that wraparound services, as often provided by the voluntary sector, are complementary to the services given by health professionals. When we are talking about supporting families and giving children the best start in life, the voluntary sector can obviously play a part. We have heard good examples of that today.

To move the subject on from birth to early parenthood, children clearly do better when both their parents are involved in their life. Where relationships are less strong, there is a risk of poorer outcomes in the long run, as we have heard today. The quality of fathers’ involvement matters more than the quantity of time they spend with their children and partner. We need to champion those who support their partners, which is facilitated by a father’s bonding with their baby or young child. When a father is an active parent, the secure attachment that is built as a consequence makes a big difference to the child as they develop their own relationships and resilience; it leads to better outcomes in life. For fathers it can be a positive experience, often helping them to re-engage with education, employment or training, and altering their outlook on life. My hon. Friend the Member for Chatham and Aylesford shared the experience of her partner’s doing exactly that.

How can we best support fathers in doing what I have described and exploring how to have the most satisfactory parenting experience? I see health visitors as our army in doing that. We have clear expectations about their work with new families. They keep an eye on them, with a view to getting the best outcomes for children and making sure that the family environment is secure. I see health visitors in that way because they often build a less formal and deferential, and more trusting, relationship with the new family. Often they are the only person who interacts with the dad. We shall be expecting health visitors to do much more to support fathers in the early months and years of a child’s life. We expect them to work to ensure that fathers are part of the holistic assessment of family fitness.

Where possible, both parents should be included in health reviews. I have heard the messages from various Members who said that that was not their experience, and we shall give a clear set of messages to the system about addressing that. Such an approach can only boost the chances of intervening early and getting proper support for the mother, the child and the father when it is needed. In doing my job I have been moved by health visitors’ accounts. We know that post-birth is a challenging time for mums, when they are most at risk of poor mental health. The feelings of isolation and helplessness on dads’ part in those circumstances are extremely difficult, and health visitors are incredibly well placed to provide support then, and steer them towards additional help.

[Fiona Bruce]

Will that encouragement of fathers include the time before the birth? As I understand matters—this is from CSJ—only about a third of fathers with a household income below £20,000 attend antenatal classes, compared with two thirds of those who are better off. One inhibiting factor is that if people cannot get a free antenatal class, a three-day course costs about £350. That is a lot of money for those who are already financially stretched.

[Jackie Doyle-Price]

The package of support that we are putting together, in terms of the continuity of carer, starts before birth and is designed to involve both parents. We are aware that there will be constraints on individuals’ ability to participate, and we need to make sure that the system is cognisant and respectful of that, and that it can make the relevant changes. My hon. Friend’s point is well made.

We need to promote initiatives such as Offload—a Warrington project for men aged 18 and over, in collaboration with rugby league. It helps men to learn the mental fitness techniques of professional sports players, to understand their own needs and help them cope. Such initiatives will enable new dads—because there is an issue with men facing up to mental health challenges—to reach out and get support from their peers.

The hon. Member for Ogmore (Chris Elmore), who is no longer in his place, raised the issue of loneliness, and my hon. Friend the Member for Chatham and Aylesford has done a great deal of work on that. Every father and family will have their own individual story. There is nothing like a life-changing experience to make one feel lonely, because all the familiar support networks are thrown in the air. We will expand social prescribing across healthcare services, so that all GPs can refer lonely patients to voluntary and community organisations. I reiterate that there is a role for the commissioning of the voluntary sector to do important work leading to better health outcomes. We will support spaces for community use, working with local groups to pilot ways to use space, to test how that can improve social connections. We need to make sure that we are keeping our eyes open for signs of loneliness, so that trusted support is given early.

In the short time I have left, I want to go further into the topic of mental health. Colleagues mentioned that 10% of fathers suffer mental ill health at the time of a child’s birth. We need to do more to support them. The “DadPack” used in Cornwall to help young fathers is a great development, and I want to champion all such models. I thank colleagues for the examples they have given.

We have had an excellent debate. It is only the start of our trying to do better at supporting dads and young families. I look forward to engaging with hon. Members on this important issue.

Question put and agreed to.

Resolved,

That this House has considered supporting fathers in early parenthood.

Mental Health First Aid in the Workplace

Jackie Doyle-Price Excerpts

Thursday 17th January 2019 Commons Chamber

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

I should like to thank all the contributors to the debate. It has been marked by a lot of enthusiasm and passionate advocacy in support of improved mental health. In particular, I would like to pay tribute to the hon. Member for Liverpool, Wavertree (Luciana Berger), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) for securing the debate and for bringing their characteristic ambitious agendas into play, alongside their well-informed and passionate advocacy on behalf of them. It can often be challenging to respond to all three of those Members, but on this occasion I have really enjoyed listening to their contributions and I agreed with much of what they said.

We all share the same objective, which is to secure support as early as possible for people who are suffering mental ill health and, more specifically, to enable more people with mental ill health to stay in work. That is good for their health—as long as it is good work and they are well supported—but it is also good for the economy when more people are encouraged to work. That was clearly illustrated by the figures cited by the hon. Member for Liverpool, Wavertree for those receiving care from Mersey Care, which bring into stark relief the size of the challenge. They show that only 3% of those patients are in work, which is something we should all reflect on. It underlines the importance of ensuring that we get better at supporting people who are suffering mental health challenges and at encouraging them into work.

I am pleased to be joined on the Front Bench by the Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She is also responsible for the Health and Safety Executive, which obviously has a big role to play in this agenda. She has been listening carefully to all Members’ contributions today. She and I are united in an objective to ensure that we keep more people with all kinds of disability in work, and that we get those who are currently excluded from the workforce into it. We have a wide package of measures that we are taking forward in that regard, some of which have been referred to today.

The Government are committed to building a country that works for everyone, and that must include ensuring that disabled people and people with mental health conditions can go as far as their talents can take them. Too many people with a mental health condition are unable to do that, and that is a burning injustice that must be tackled. As the right hon. Member for North Norfolk pointed out, people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That statistic illustrates why it is good for society, as well as for the individual, that we tackle this issue. The good news is that staying in or returning to work after a period of mental ill health really does aid mental health recovery. It really does make perfect sense.

[Norman Lamb]

The Minister will be aware of the objective in the five year forward view to double the number of people who get access to individual placement and support. Can she indicate how that programme is going? If she cannot do so now, will she write to me?

[Jackie Doyle-Price]

I can say that we are making progress, but I would prefer to write to the right hon. Gentleman with more details, if I may. I have seen some of that individual placement and support in operation, and it is hugely inspiring. In those mental health trusts that are giving one-to-one support, people are finding that the reward and discipline of going to work really does aid their recovery, even in some of the most challenging cases. I will write to the right hon. Gentleman with more information on that.

[Mr Kevan Jones]

Will the Minister liaise with colleagues in the Department for Work and Pensions? As I said to the right hon. Member for North Norfolk (Norman Lamb), voluntary work is a helpful access point for people who want to get back into work, and the current limitations on people being allowed to do certain voluntary work hinder some who want to take that route into work.

--- Later in debate ---

[Jackie Doyle-Price]

I completely agree with the right hon. Gentleman, and my hon. Friend the Minister for Disabled People, Health and Work agrees too. Employers are often risk-averse about using voluntary work, and we in government need to ensure that we are making it easy for people to apply for those routes. My hon. Friend says she will write to the right hon. Gentleman on that matter.

A number of points have been raised in this debate. On the issue of mental health first aid in schools, I can advise the hon. Member for Wakefield (Mary Creagh), who is not in her place, that the Government have a commitment to ensuring that at least one member of staff in each primary and secondary school receives mental health first aid training. We have currently reached 1,537 schools with that training.

I am delighted to hear from my constituency neighbour, the hon. Member for Dagenham and Rainham (Jon Cruddas). Like him, I am well aware of much of Ford’s activity, and it is good to hear what it has been doing in this regard.

My hon. Friend the Member for Waveney (Peter Aldous) highlighted the work of St John Ambulance in promoting mental health first aid and, again, I commend its work. The right hon. Member for North Durham (Mr Jones) made the excellent point that this is a cross-governmental issue. I have mentioned DWP, but the five year forward view carries the message that this issue must be tackled across Government, and we remain focused on delivering exactly that.

The Prime Minister has set out an ambitious set of reforms to improve mental health. We have heard references to parity of esteem, and I reiterate to all hon. Members that the fact that parity of esteem is written into legislation is not the end; it is just the start. The truth is that, in delivering true parity of esteem, we have to manage a programme of behavioural change throughout our services and, indeed, throughout society. Frankly, none of us should ever be complacent about whether we have achieved it. Parity of esteem will take a lot of time, and it is great to see just how much energy is being applied to it.

We have heard a number of references to Time to Change, and it is clear that the cultural transformation in society has been massively aided by Time to Change and that destigmatisation is really helping with delivery. None the less, we have a big role to play in service provision. We are creating 21,000 new posts in the mental health workforce. We are implementing the first waiting time ambitions for mental health so that people have faster access to the care they need. We have recently published the first review of mental health legislation in a number of years. And, of course, we are massively improving early intervention by investing in more services in schools.

We are investing more through the 10-year plan, and the Prime Minister has announced that the NHS budget will grow by over £20 billion. In turn, in the long-term plan published last week, the NHS confirmed that there will be a comprehensive expansion of mental health services, with an additional £2.3 billion in real terms by 2023-24. The ambition is that that will give 380,000 more adults access to psychological therapies and 345,000 more children and young people greater support in the next five years.

We are ambitious, although I do not pretend that, by putting it into law, we have suddenly achieved parity of esteem. We are on a journey in how we commission and deliver services and, of course, in how we behave across society. There is still much to do, not least in the workforce. Destigmatising mental ill health is contributing to understanding and challenging the prejudice and stigma, but we still need to do more.

We have heard much reference to the Farmer-Stevenson review. The Prime Minister appointed them to advise us on how employers can better support all employees to remain and thrive in work. We set out a broad-ranging strategy further to support disabled people and people with health conditions, including mental health ones, to enter into and thrive in work. We did that through our response, where we accepted all those recommendations; indeed, the leadership council to deliver that met only this morning. The work and health unit, which I lead jointly with the Minister for Disabled People, Health and Work, will be overseeing progress on those recommendations, which range from short-term deliverables to longer-term reform. That will include looking at potential legislation in due course.

The key Thriving at Work recommendation is that all employers, regardless of size or industry, should adopt six core standards that lay the basic foundations for an approach to workplace mental health. The review also recommended that all public sector employers, and private sector companies with more than 500 employees, deliver mental health enhanced standards. Those include increasing transparency and accountability through internal and external reporting of their performance against those standards. The Prime Minister accepted those recommendations that apply across the civil service and NHS England. The civil service, as an employer of 420,000 employees, really should be leading by example on this. Equally, the NHS, as both the provider of services and as a large employer, should be leading the way.

The Government have also taken action to work with partners to develop a framework to support organisations to record and report their performance on disability and mental health in the workplace. Last November, we published that voluntary framework, which highlights transparency and reporting as the effective levers in driving the cultural change we need to develop. But we know that every line manager, supervisor and leader has a crucial role to play in supporting employees to stay well and stay in work, which is why the work and health unit is also working with partners to identify the support and skills that line managers need, across all sizes of organisation, to create inclusive and supportive workplace environments. So we are exploring how we in government can share those examples of best practice, so that all employers get better at this. Many of them will recognise that they need the tools to do the job, because no one knows what they do not know, and we in government have a role to play in spreading that good practice.

We recognise that mental health first aid has a role to play in the Government’s ambitious strategy to transform workplace mental health. Mental health first aid is a helpful training resource to educate people to care not only for others, but for themselves. It also helps to improve understanding about mental health and mental illness; to build that culture and better understanding within organisations; and to encourage people to stay well and get the support they need to manage any mental health symptoms and problems. I was also struck by what the right hon. Member for North Norfolk said: on its own, it is not enough. We would not want to have legislation that became a floor of service in mental health.

A number of references have been made to Thames Water and its success in delivering mental health first aid, all of which is true, but mental health first aid is just part of its embedding a supportive workplace culture for those with mental ill health; it is not the only tool that the company uses. It has introduced mental health first aiders across the business, but it has also expanded its internal clinical occupational health team to support the business in case management, health screening, health surveillance and well-being. The occupational health team now processes an average of 100 referrals a month, 98% of which are for non-work-related issues. Up to 80% of the cases referred every month are for those still in work, which shows that people are accessing longer-term care; this is about keeping them in work, rather than just their getting mental health first aid. We need to be careful about honing in on one simple measure of supporting mental health in the workplace, rather than encouraging a more holistic culture of supporting wellbeing.

I can also advise the House that the Health and Safety Executive, working together with Mental Health First Aid England, has recently published revised guidance for employers on their compliance with the Health and Safety (First-Aid) Regulations 1981. The guidance clarifies for employers the existing requirement to consider mental health alongside physical health when undertaking a first aid needs assessment. The findings from the needs assessment will help direct employers to decide what measures they need to put in place.

The advice of the Health and Safety Executive is that the Stevenson and Farmer review recommendations go way beyond the provision of mental health first aid. The Government’s view is that the best way to secure employer action, to enable those experiencing mental ill health to remain and thrive in work, is to engage with employers to adopt a comprehensive approach based on the Thriving at Work mental health standards. Mental health first aid is not an exclusive way of delivering employer action, but it can form part of it.

To improve information and advice for employers, we are supporting Mind and the Royal Foundation to continue developing their mental health at work online gateway, which we launched on 11 September 2018. The online platform is aimed at employers, senior management and line managers but is accessible to anyone, and it helps them to find help and support for colleagues, to challenge stigma and to learn more about mental health in the workplace. The guided search tool helps with the development of toolkits, blogs and case studies to help everyone in their journey to improve the workplace. Mental Health at Work is a UK-wide initiative that supports people across all workplaces, in all sectors, of all backgrounds, and in all regions.

In conclusion, by working with our partners, including health professionals and employers, this Government are working to change culture and professional practice fundamentally, to tackle poor mental health and to ensure that disabled people and people with health conditions can reach their full potential, not only in the workplace but across society as a whole.

I thank all Members for their contributions and for their interest in the subject. We need to continue to discuss the issues and to encourage good practice. We have heard many good examples today, but we need to consider debating the issues so that we genuinely foster a culture at work that supports people with disabilities and with mental ill health to get jobs and to stay in work.