Health and Care Professions Council: Registration Fees

Jim Shannon Excerpts

Thursday 14th March 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am always surprised when I am called early, Mr McCabe, but it is always a pleasure to speak in such debates.

I thank the hon. Member for Coventry South (Mr Cunningham), who is a friend as well as a colleague, for obtaining the debate. I, along with many others, signed the original early-day motion, as he mentioned. I have had the benefit of his knowledge in studying the background and making sure we were on the same page. When he told me the story, it resonated with me and I knew it would resonate with my constituents and with people back home who work in the caring services. It will therefore come as no surprise if my comments echo those of the hon. Gentleman.

I thank the hon. Gentleman for persevering with the matters he is interested in. He was a Member when I first came to the House, and the two of us made friends quickly and have worked together on many things. I would say that he has signed all my EDMs and I have probably signed all his, so we have a mutual understanding. That is not because we are friends, but because we are of the same mind on the issues and we work together on them. I am pleased to do it. I think I signed his Coventry City early-day motion, and I think he even signed mine on Leicester City, so there we are. We crossed that divide as well.

I, like many Members in this Chamber, have been a consistent advocate of a pay increase for NHS staff. I lobbied the Government for it when my party came into the confidence and supply arrangement, and we thank them for the increase that they gave in response. I am fighting to equalise nurses’ pay on the mainland and in Northern Ireland, because there is a differential and we must close the gap. I am endeavouring, with the Department of Health in Northern Ireland and the permanent secretary, to ensure that we move closer together. It is very simple to me: I see a group of civil servants working in conditions that are not acceptable and I know that what they should be paid is vastly more than what is there. We need to pay them what they should be paid. We appreciate them and all that they do, as the hon. Member for Coventry South said, and I thank them too.

I had occasion about two years ago to be cared for by nurses in hospital, so I know how much they do. I was there three times that year. The 1.5% rise does not seem like a huge amount, yet the staff felt that it was a gesture of appreciation. It was important that we made a move in that direction. The Government’s agreement was 3% over a five-year period. To accept, in the same breath, an 18% increase in the fee to practise is shocking and far outweighs any gesture we have made. Such an increase will mean a 40% rise in HCPC fees since 2014. How can that be acceptable? There is no fairness or sense of balance in the process.

I always relate my speeches in the House to what happens in Strangford, so that the people there know I am industrious on their behalf. The Strangford example I want to use today is of a district nurse who approached me a few weeks ago. She complained that those who have gone to the private sector to carry out personal independence payment assessments and the like not only get to work nine-to-five, have a company car and a higher wage, and are not run off their feet in an understaffed ward; they also have their registration fees paid. They get better conditions in the private sector, and their fees are paid, so we can understand how NHS professionals feel. My constituent said it is little wonder that wards are crying out for qualified nurses, while the assessors can find people left, right and centre. We have a dearth of nurses in Northern Ireland and are 1,500 short. The Minister knows I understand that that is not his responsibility; I say it just to show the situation we are in. We simply cannot compete with the private sector, but why are we competing against ourselves with the PIP assessments, which are carried out with public money? We are robbing Peter to pay Paul, and that needs to end.

We need to take the opportunity to assure paramedics, occupational therapists, operating department practitioners, physiotherapists, radiographers, dieticians, chiropodists, podiatrists, orthoptists, clinical scientists and speech and language therapists that to ask them for a 40% increase in fees over five years is not acceptable. Yes, it may be only a pound a month, as some people have said, but the fact is that all bills, from gas to petrol to food, have risen. The issue is the combination of all those increases in bills. They all contribute to the lowering of income. We should want to encourage NHS practitioners—those in the health and care professions—to stay there and work in their vocation of choice.

I firmly believe that a message must be sent today from this place that we support health and care professionals in their fight for fairness and equality, and that we oppose the rise or will pay the fees on behalf of those who work full time in our NHS as part of our thank you to them. That would be an endorsement of their commitment to us as their patients. It is not even £9 a month per staff member, so can the Government not look after this and ensure that it is paid for NHS staff? Why are we asking them to pay it while those who work privately have theirs paid for? The issue is the imbalance. Those who work privately have this paid for, but that does not happen in the NHS. That is not the right message to send to dedicated NHS workers, and we must do better.

Community Hospitals

Jim Shannon Excerpts

Tuesday 12th March 2019 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I was pleased to note that on announcing his long-term plan for the NHS, the Secretary of State for Health and Social Care said he is a strong supporter of community hospitals, so I am today asking if Health Ministers will kindly look into how some of the additional resources announced with the long-term plan can be earmarked for the community care provided by community hospitals, such as the much loved Congleton War Memorial Hospital in my constituency.

Congleton Hospital needs sufficient resources to ensure that it can continue to provide the all-round services it has already provided for several generations of my constituents for generations to come. The hospital is much valued locally, providing a range of services, such as the minor injuries unit, which saves residents travelling some distance to hospitals further afield with A&E facilities. Minor injuries such as burns, cuts, splinters and sprains can be treated quickly and efficiently at Congleton. As one person, who sustained a hand injury, told me:

“I popped down to Congleton Hospital, the wound was treated straight away and I was back at work within the hour.”

That person would have lost at least half a day’s work travelling for treatment elsewhere.

In recent winters, the minor injuries unit has, on occasion, been closed temporarily by East Cheshire NHS Trust, with staff redeployed to Macclesfield’s A&E. Then, in September 2018, the trust stated that it expected closures to be in place throughout weekends and bank holidays, plus ad hoc weekdays, throughout this winter. As a result, the minor injuries unit is currently scheduled to open only between 9 am and 5 pm from Monday to Friday, but with additional ad hoc closures within these hours. It was not open, for example, when I visited last Friday afternoon.

It is therefore not surprising that some people in need of urgent treatment decide not to risk calling at a unit that may be closed unpredictably, with user numbers no doubt affected accordingly. It is also understandable that these closures are causing grave concern among local people. On their behalf, I am calling on Ministers to ensure, please, that resources are put in place so that valuable community hospital facilities such as Congleton Hospital’s minor injuries unit are not only stabilised but strengthened.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this issue to the Chamber. I spoke to her beforehand to ask what her thoughts were on this issue and how I might helpfully intervene. I spoke to the Minister, too. In the past few weeks, the national and provincial press have highlighted a number of incidents in hospitals. They report NHS staff referring to “war zone” conditions in A&Es. The community hospitals the hon. Lady refers to are vital for the treatment of patients, but it is also good for the mental health of NHS staff to have hospitals where they can do their job—their duty—without facing any injury or threat to their life.

Depersonalisation Disorder: NHS Treatment

Jim Shannon Excerpts

Tuesday 12th March 2019 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

It is an absolute pleasure to serve under your chairmanship, Mr Gray.

In the 2017 Christmas Adjournment debate I spoke about depersonalisation disorder, or DPD. I told something of the story of my constituent Jane, and requested a meeting to discuss NHS treatment of DPD. Since then the Minister has kindly met with me, Jane and Dr Elaine Hunter, a leading DPD clinician. The meeting was very sympathetic and I thank the Minister for that. We agreed that we would follow it up with a short Westminster Hall debate, to speak publicly about why the issue is so important. I shall therefore take the opportunity to talk about depersonalisation and put a couple of what I hope are gentle asks on the table.

What is depersonalisation? DPD can be triggered by a traumatic experience, a panic attack, stress or, indeed, drug use. It is a fairly common psychological or mental process for dealing with trauma. It feels as if the mind is detaching from the body; those affected feel as if they are outside themselves. Everything feels rather unreal. I have certainly felt that way before, at a time of significant and severe stress. However, depersonalisation is an intensified version of the feeling, and it is not temporary. It sets in indefinitely. When people have DPD it will often be accompanied by the sensation of noticing themselves as if from the outside, as if they are a character on a screen—almost as a character in the play of their life. The feeling can be so strong that those who have DPD are less aware of their bodily sensations, such as their heartbeat.

DPD is different from a psychosis such as schizophrenia because people who have it are aware that the experience is subjective, and not something changing in the world around them. A common difficulty for those with DPD is putting the experience into words. Many use metaphors or similes, comparing their experience to watching a TV screen. They may use adjectives such as “fuzzy” or “blurry” to describe how they feel. The lack of awareness of the condition, combined with the difficulty in communicating the precise symptoms, is the reason why many are repeatedly misdiagnosed.

[Jim Shannon (Strangford) (DUP)]

I was present on the previous occasion when the hon. Lady raised this subject. I was quite alarmed when I did some research on the disorder that she has described. I am sure that she knows the figures. According to studies in the United Kingdom and the United States, DPD affects some 2% of the population—1.3 million people in the United Kingdom and 6.4 million in the US. The hon. Lady is clearly raising awareness today, but is there a greater need to raise awareness among GPs, to make sure that they can make early diagnoses, and understand and respond to the condition?

[Lyn Brown]

I absolutely agree with the hon. Gentleman. I want to talk later in my speech about how many people experience the condition, and about other conditions that similar numbers of people are diagnosed with but that are far more common and have more resources from the NHS. I will go on to argue that DPD is fairly significant, given the number of people affected, and that more resources and effort are needed to assist them.

Many sufferers, as I mentioned, are misdiagnosed— often for years on end. Often when someone with depersonalisation disorder is misdiagnosed they are given medication, which can either have little effect or be quite harmful. Naming the symptoms and people understanding what has happened to them can be an important experience. Understanding the condition and putting a name to what they have can make someone feel an awful lot better. My constituent Jane Charlton struggled terribly before she was diagnosed. She imagined that she might have a degenerative disease, or that she might be dying. Learning the name of the condition was a crucial step in understanding it, living with it and eventually learning ways of dealing with it.

The onset of DPD was triggered for Jane by cannabis use. She was just 18, on holiday with a boyfriend, and had smoked cannabis only once before. Her boyfriend prepared her some cannabis resin and mixed it into a yoghurt. Jane tried a little—no impact; so she tried a bit more. She describes what happened next:

“My perception drew back into my head, almost as though I was now looking at the world from the back of my own eye sockets. I perceived a delay between an external event, and my brain understanding or processing it. Suddenly there was a fracture between the world and me. While my body was still in the world, my mind had become a disengaged observer.”

As I said, in DPD the individual is aware that their perception has changed, so although the experience feels like a blurring or a distancing, for Jane it was terrifying:

“During that first episode…hours followed where I sought reassurance from those around me, wanting to touch and talk to them constantly. I wanted to check that I still existed. Eventually, exhausted, I slept, in the hope that it would pass overnight. It didn’t. The next morning, the shift in perception remained, and would in fact remain for every second of every day for the next three years.”

A temporary experience of depersonalisation can serve as a defence mechanism if there is a traumatic event. It allows separation from immediate reality, but if it spreads beyond that and becomes depersonalisation disorder, people such as Jane can become separated from other emotions as well:

“If I quieten my mind, I can almost taste the colour and richness of life as I knew it before...but I can barely remember what it feels like. These days I’m in a constant state of grief; I feel as if I’m grieving for my own death, even if I seem to be around to witness it.”

It is hard to imagine the impact that that would have on a young person’s life, for those of us who have not felt it. For three years, in Jane’s case, there was no diagnosis and no remedy. Even with the right diagnosis DPD is hard to treat. Jane has had four major episodes of depersonalisation disorder, despite all her hard work, often with experts in the field. Her current episode is ongoing, and entering its fifth year.

Another person who has depersonalisation is Joe Perkins. He runs a YouTube channel called the “DPD Diaries”, which is a wonderful accessible resource for learning about the condition. Joe told me he has had about 100 medical appointments over the past 10 years, but he can count on one hand the number of professionals who had actually heard of the condition. His diagnosis took 10 years. Sadly, that is a normal length of time in the NHS at the moment. He had 10 years living with DPD and not understanding that it was a recognised medical condition and he was not on his own. He explained his experience of the condition:

“The most difficult thing for me to deal with day to day is a complete lack of emotions. I experience neither happiness or sadness; life seems completely flat; and it’s very difficult to feel motivated for anything when everything feels meaningless. Having to explain to your partner that you’re unable to feel love for them is an incredibly difficult conversation to have—and one that naturally puts a huge strain on any relationship.”

I am sure we can all understand that.

Joe first started experiencing symptoms while he was studying for A-levels, when he was too young to be eligible for treatment at the Maudsley clinic, the only facility available in the UK. Fortunately, he has since started to receive treatment. The referral took a full year, and the waiting list is long, with numbers spiralling as awareness rightly grows.

The invisibility of DPD makes it all the more important that we speak about it in this place, and I am grateful to have had the opportunity today to do just that. Just a few facts will show that depersonalisation and derealisation—a closely related condition—are an urgent concern and need far better treatment under the NHS.

First, depersonalisation and derealisation have symptoms that many of us will find familiar; 75% of us will have experiences similar to depersonalisation at some point in our lives. Secondly, as the hon. Member for Strangford (Jim Shannon) said, between 1% and 2.4% of people are likely to have these conditions—a similar level to bipolar disorder, which is far better understood and resourced, and which our GPs and experts are able to spot.

Thirdly, it is important to know that there is only one small clinic in the UK that specialises in treating the condition and, as I have said, it does not treat people under the age of 18, despite the fact that sufferers from depersonalisation disorder typically have their first experience of it in their adolescence. Finally, and rather damningly, the average diagnosis takes between eight and 12 years from the point of symptoms appearing. Those are the facts I have received.

I have talked about what DPD is, what it feels like, and the fact that it is very poorly known, which helps to explain the almost unbelievable figure of eight to 12 years to diagnosis. How debilitating DPD can be is the most important thing to understand, but the lack of provision is extremely important, too. We have a lot of work to do if we are to build the same scale and quality of NHS support for those with DPD as for those with depression or bipolar disorder.

I pay tribute to Jane for all the work she has done on this issue. She is a brave woman. She featured in an article in The Guardian in 2015, which reached a huge number of people. In 2017, she followed that up with an appearance on the Victoria Derbyshire programme. During the programme, several people called the show to say that Jane had helped them to recognise their own condition.

Jane continues to raise awareness through lobbying—she lobbied me—and runs a peer support group for people suffering from DPD, so they can experience solidarity and share experiences. She has also founded a charity called Unreal, to unify all the different bits of work being done. Jane has done all of that while holding down a full-time job and dealing with her own DPD. She has my absolute respect and gratitude for that. Jane’s work is really helping, but we need to go so much further to spread awareness not only among members of the public, but among NHS professionals.

As I said at the start, Jane, Dr Hunter and I have already met the Minister, and I am hopeful that she will be able to tell us more about what action is already being taken, but I would like to use this opportunity to put on record our four asks. All of them can be accomplished within the next few years, and none, we think, would require huge investment of resources.

First, on training, a 2017 edition of The BMJ published new guidance on the assessment and management of DPD. That was very welcome, but it has not led, and will not lead, to better and faster diagnosis and treatment in and of itself. My first ask is that the Minister write to the presidents of the Royal College of General Practitioners and the Royal College of Psychiatrists, to request that they bring this information to the attention of their members and ensure that training on DPD is made part of the core training for GPs and psychiatrists.

Secondly, I ask the Minister to push for the design and delivery of a programme of training in NHS mental health trusts around the country, not only to raise awareness, but to improve assessment and management of the disorder locally. That could include the appointment of a local depersonalisation disorder lead, who can thereafter provide guidance to local clinicians.

My third request is that those leads link together to improve access to treatment for those with the condition. I think the Minister would agree that it is not good enough to have just one small clinic at the Maudsley treating all those people across the country who have depersonalisation; we need better and more. Finally, given that expert support for young people experiencing DPD simply does not exist in the NHS, I ask her to ensure that there is specialist provision in child and adolescent mental health services, so that those under 18 can receive treatment when they need it.

Those simple steps could make a difference and bring down the average diagnosis time from an absurd and unacceptable eight to 12 years. They will help to ensure that no matter where someone lives, if they go to their GP, help will be available. So many people live in silence with this largely invisible condition. We have a long way to go to guarantee effective diagnosis and treatment for them on the NHS, but these four asks, if realised, would, I hope, start us down a good path.

Health and Social Care Committee

Jim Shannon Excerpts

Thursday 28th February 2019 Westminster Hall

[Dr Williams]

I thank the hon. Gentleman for his advice and input at the start of the inquiry, and for the work that he has done as the chair of the all-party group, which is about the first 1,001 days—what is a day between friends? The economic case is exceptionally strong, and I am sure that the Minister has heard him make it eloquently. We all need to work together to make sure that we put the case to the Treasury. Ultimately, those spending decisions will have to be made in the comprehensive spending review; that feels like an opportune time.

The hon. Gentleman suggested that we ensure that there is a timeframe, that the commitment is not open-ended, and that local authorities have plans within a short time. We learned in our inquiry that local authorities are often left to just get on with it. The Committee felt that there was a need for much more central control and measurement, and for more accountability by central Government.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Stockton South (Dr Williams) on setting the scene so very well, and I thank the Chair of the Committee, the hon. Member for Totnes (Dr Wollaston), and the other members of the Committee for all that they have done to produce what I regard as a very helpful and significant publication.

The Government do not provide financial or practical help for parents of multiples. That needs to change. If someone is blessed with twins, triplets or more, they are on their own. What consideration did the Committee give to addressing this issue, as we have many concerns in this Chamber about the two-child tax credit limit?

Secondly, each year thousands of parents are forced to go back to work when their baby is still critically ill, as provisions for maternity and paternity leave are inadequate. Again, what consideration did the Committee give to combating this? It is not unreasonable to extend statutory leave and pay for parents whose baby is admitted to neonatal care by a week for every week that their baby stays in hospital. I will just explain that, because I may have rushed through it as quickly as I can, in my usual quick way. The parent of a baby who is premature, and whose peers at four months are rolling over, will be told by a health visitor not to worry, as their baby is not considered to be four months old. However, the fact is that when it comes to wages and money, that baby is considered to be that age, and the cost is £2,256 per family, so there is a financial strain.

Thirdly and lastly, nearly three quarters of multiple birth families get no discount on their childcare costs, and for triplets those costs can be as high as £2,500 per month. It is quite clear that that is not sustainable; unfortunately, it usually rings the death knell for someone’s career. What consideration was given to that issue in this report?

[Dr Williams]

I thank the hon. Member for so eloquently making the case on an issue that we did not look at specifically in the report; we did not look at multiple-child families. However, we made some comments in a more general way.

I will make two points in response. The first is that providing services to families is not enough. The whole environment in which they live, including the poverty that many families find themselves living in, is probably as important as the provision of services. The second point, which we make in the report, is that we should consider the impact on the early years in all policies as a principle—as a “health in all policies” principle—and we should particularly consider the impact of all policies on the developing brain of children. We state that very clearly as a recommendation in our report.

Dental Health: Older People

Jim Shannon Excerpts

Wednesday 27th February 2019 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

This Adjournment debate provides an opportunity to discuss a very important but often overlooked issue, which can have a major impact on the wellbeing of older people: their oral health. Many of us will have older relatives who have reached the stage where they need some extra support. It might be that they live in a residential care home, have a carer who visits them in their home a couple of times a week, or just require a bit of extra help from us personally to stay independent.

However, one issue that often slips under the radar when we think about an older relative’s needs is their oral health; it can often seem like a small issue, but in fact poor oral health can have much wider implications. Having a painful oral health problem can impact on someone’s ability to eat comfortably, to speak and to socialise with confidence, and on the ease with which they can take medication, something which may be a particular issue if an older person is living with other long-term health conditions. Maintaining good oral health can also become much more challenging for older people with reduced dexterity, who may for example have more difficulty with brushing their teeth. Furthermore, for the most vulnerable older people, such as those with dementia, who may have difficulty communicating where they are experiencing pain, an oral health problem can be especially distressing.

Ensuring that older people are supported to maintain good oral health, and have access to dental services when they need them, is therefore very important. However, while data on this issue is limited, the information that we do have suggests that these are areas in which we often fall short.

The Faculty of Dental Surgery of the Royal College of Surgeons published a report on “Improving older people’s oral health” in 2017, which estimated that 1.8 million people aged 65 and over in England, Wales and Northern Ireland could have an urgent dental condition such as dental pain, oral sepsis or extensive untreated decay. Moreover, the Faculty of Dental Surgery also highlighted that this number could increase to 2.7 million by 2040 as a result of several demographic factors, thereby increasing pressure on dental services in the future. As well as the ageing nature of Britain’s population, increasing numbers of people are also retaining their natural teeth into old age; while this is good news, it also means that dental professionals are facing new challenges as they have to provide increasingly complex treatment to teeth that may already have been heavily restored.

Separately, in 2014 Public Health England published the findings of research looking at oral health services for dependent older people in north-west England, which found that access to domiciliary and emergency dental care can often be very challenging for those living in residential care homes or receiving “care in your home” support services. More recently, Public Health England last year published the results of a national oral health survey of dependent older people living in supported housing. This revealed that nearly 70% of respondents had visible plaque and 61% had visible tartar, indicators of poor oral hygiene, and that in some parts of the country, such as County Durham and Ealing, over a quarter of dependent older people would be unable to visit a dentist and so required domiciliary care in their home.

It is difficult to get a complete up-to-date picture of the oral health needs of older people across the country, partly because there has not been an adult dental health survey for 10 years, an issue I will return to later. However, these figures, as well as anecdotal reports from dental professionals working on the frontline, suggest there is a real issue here which potentially impacts on large numbers of often vulnerable older people.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this important issue to the House. As he said, 1.8 million elderly people across the United Kingdom of Great Britain and Northern Ireland have problems, which is shocking. The hon. Gentleman outlined some of the solutions such as extra attention on domiciliary care and in residential homes, and for those at home and dependent on carers. Does he agree that older people’s confidence can also be diminished by not having their teeth correctly done? My mother went this week to have her teeth done; she is 87 years of age and she depends very much on her dentist. She has attended over the years, but many have not, and we need to have that care at all those different levels.

[Andrew Selous]

I am grateful to the hon. Gentleman for giving us his personal family experience of this issue.

There have been some welcome developments over the last few months, including the recently published NHS long-term plan highlighting oral health as one of the priorities for NHS England as it rolls out a new “Enhanced health in care homes” programme across the country. However, I would like to draw the Minister’s attention to five particular areas in which more could usefully be done: training for health and social care professionals; access to dental services; data; regulation; and the social care Green Paper.

First, on training, health and social care professionals regularly do a brilliant job of caring for older people, but as I have mentioned, oral health is one issue that can easily fall between the cracks, particularly if someone is living with a range of other health conditions that also require care and attention. One example of this is oral care plans. Ideally, whenever someone is admitted as a resident to a care home, their oral health needs should be considered as part of their initial health assessment. Those needs should then be reflected in an oral care plan that all their carers are aware of and that will, for example, set out whether the resident needs extra help brushing their teeth.

There is some good guidance from the National Institute for Health and Clinical Excellence, but this can often be overlooked. In Public Health England’s research in north-west England, 57% of residential care home managers said that they did not have an oral care policy, and one in 10 said that an oral health assessment was not undertaken at the start of care provision. Knowing how to provide good oral care is especially important when it comes to supporting those with more complex needs. For example, for those with dementia, electric toothbrushes can sometimes be quite intimidating, and it makes a big difference if a carer knows that they should use a manual toothbrush when helping with tooth brushing. More broadly, if someone who is living with dementia refuses oral care, this can become an obstacle to maintaining good oral health, so it is important that carers understand how to manage these situations, ideally with input from a dental care professional.

Equally, for those with dentures, it is important that training and procedures are in place to minimise the risk of a denture getting lost, even if this is a simple thing such as ensuring that they are kept in a jar by the bedside when not in use. A lost denture takes weeks to replace, and this can be a devastating experience for an older person who relies on them to eat and speak. This is particularly sensitive if someone is coming to the end of their life, when it may not be possible to manufacture a replacement in time as they spend their remaining days with loved ones. An understanding of good denture care is particularly important in these situations.

Improving awareness of oral health among health and care professionals should therefore be a priority, and was a key recommendation in the Faculty of Dental Surgery’s 2017 report. This highlighted schemes such as the Mouth Care Matters programme, in which mouth care leads are recruited to provide oral care training to staff in hospitals and care homes, and I would be interested to know from the Minister whether there were any plans to replicate such initiatives nationwide.

Secondly, ensuring that older people can access dental services when they need them is essential. It is not uncommon for people to think that if someone has no teeth, they cannot be experiencing pain or other oral problems. Sadly, this is not the case and they should still have an oral check-up once a year, not least because the majority of cases of oral cancer occur in people over 50. There are all too many tragic instances of an older person being diagnosed with oral cancer too late—the saddest two words in the English language—simply because they had not seen a dentist in a number of years. Attending a dental appointment can be a particular challenge for those with reduced mobility—for example, if they are unable to climb stairs to reach a dental practice on the first floor—in which case, domiciliary visits are vital. However, evidence suggests that access to domiciliary dental care can be challenging, particularly for those living in care homes or supported housing, and I would appreciate the Minister’s thoughts on how we can address this.

In 2015, Healthwatch Bolton reported that it was easier for a local care home resident to get access to a hairdresser than to a dentist. In 2016, Healthwatch Kent reported that care homes had told it about accessibility problems for wheelchair users within dental practices. In 2016, Healthwatch Lancashire reported that care home staff said:

“The residents don’t get regular checks; they are only seen when there is a problem.”

Healthwatch Derby was concerned about the lack of information for social care providers about how to access dental services for their residents. While the commitment in the NHS long-term plan to

“ensure that individuals are supported to have good oral health”

in care homes under the “Enhanced health in care homes” section is welcome, there is no mention of a similar commitment for older people who use domiciliary care agencies. Those people should not be forgotten, so what do the Government intend to do about that for domiciliary care agency users under the NHS long-term plan?

Thirdly, the intelligence around older people’s oral health is quite limited, making it difficult to build a full picture of the level of need or assess the barriers that older people face in accessing dental care. The most immediate action that could be taken to address that would be for the Government to commission a new adult dental health survey. It is one of the few resources to provide detailed, national-level data on standards of oral health among older people, and it is a key reference for many commissioners, policy makers and dental professionals. The survey has been conducted every 10 years since 1968, but the last edition was published in 2009, so a new one is due. However, the Government have yet to give any indication of when or if a new survey will be taking place, which is causing increasing concern within the dental profession, so an update on that would be most welcome.

There are other steps that would help to improve our understanding of such issues. For example, NHS Digital publishes a regular set of NHS dental statistics for England, which reports on the proportion of children aged zero to 17 who attended an NHS dentist in the preceding 12 months, as well as the proportion of adults aged 18 and over who attended an NHS dentist in the past two years. That data provides a useful measure of access, and expanding the figures to include attendance rates for older people would help us to develop a clearer picture of whether there are particular groups or areas where access to an NHS dentist is a problem.

[Jim Shannon]

Many elderly people are independent and proud, and one of the things that puts them off attending the dentist—I see this in my constituency—is that they think they have to pay for the treatment, but they do not. Perhaps we need to put out a reminder about that.

[Andrew Selous]

I am grateful to the hon. Gentleman for putting that on the record.

Fourthly, in addition to health services, care home providers and dental professionals, regulators can play an essential role by monitoring standards of oral care and driving improvements. The Care Quality Commission in England does not explicitly look at oral health during its inspections of hospitals and care homes, although I understand that it is doing a lot of work behind the scenes to try and push that on to the agenda for care providers, which is obviously welcome. Health and care regulators in other parts of the UK can also make a valuable contribution to ensuring that the importance of oral health is recognised by those that they inspect.

Lastly, I continue to look forward to the publication of the Government’s long-awaited social care Green Paper. Given the importance of oral health to our wider health and wellbeing, an all-encompassing model of care for older people must include dental services, so it will be important that the Green Paper clearly sets out how social care and dental services can work together in the future and what more can be done to ensure that older people have access to dental services when they need them. As I have mentioned, one of the most valuable things we can do to improve older people’s oral health is to ensure that it is not overlooked amid the many other issues that we are dealing with, and I hope that the Government will show leadership on that in the Green Paper.

Oral health can sometimes seem like a small issue, but it has a significant impact on quality of life. The Minister will be aware that we have spoken a lot in recent years about the need to improve children’s oral health, and quite rightly so, but it is also essential that we do not take our eye off the other groups who need support. For an older person who is in pain because of an oral health problem, finding it difficult to eat or speak, or who may be distressed at the loss of a denture that will take weeks to replace, such issues are very real. We can all contribute to addressing them, including Members who care for older relatives in our everyday lives. Indeed, the Faculty of Dental Surgery published some useful advice over Christmas about using visits to older relatives as an opportunity to check their oral health and for how to spot the signs that they might have an oral health problem. That is something that Members could do over Easter when visiting elderly relatives, and we could encourage our constituents to do the same. However, I hope that the Minister will recognise that Government also have an important role to play and will look carefully at what can be done to help improve oral care for our older people.

Eating Disorders Awareness Week

Jim Shannon Excerpts

Wednesday 27th February 2019 Westminster Hall

[Paula Sherriff (Dewsbury) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I sincerely thank the hon. Member for Angus (Kirstene Hair) for securing this very important debate today, particularly during Eating Disorders Awareness Week. I was deeply moved by her powerful opening speech and I thank her and the hon. Member for Bath (Wera Hobhouse) for their persistence in bringing the issue to the House. May that never stop.

It is only four months since we were last here speaking about this issue and how we could work together to remove the stigma around eating disorders. Many colleagues here today also spoke in that debate and I thank all of them for taking the time to be here again today. I have been struck, as I am sure many have, by the collegial nature of this debate. That is important and it is what people who experience eating disorders, and their families, want. They want us to put our party colours to one side and work together to try to bring about the much- needed improvements in this area.

My hon. Friend the Member for Islwyn (Chris Evans) talked eloquently and powerfully about the issue. As we all know, it is brave to talk about our personal experiences in this place, and he talked about his own experience of body dysmorphia. He also talked about the bravery of others, but I hope he takes time to reflect on his own bravery and courage. I am very proud of him and I thank him.

I also want to reflect on the comments made by the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) about what happens in schools, which is incredibly important. The hon. Member for Angus also touched on it. I recently attended one of the high schools in my area and talked about what psychological support was available to children, specifically teenagers.

[Jim Shannon (Strangford) (DUP)]

I apologise that I could not be here earlier; I was at the Northern Ireland Affairs Committee. Over the years, I have had the opportunity to help some of my constituents, particularly ladies, who have had eating disorders, and we have been able to sort those things out. I have noticed a dearth among males, who unfortunately seem not to address these issues. I commend the hon. Member for Islwyn (Chris Evans) for speaking about that.

The hon. Lady talked about helping schools, youth groups, and other youth network facilities. I believe that there is a need for trained officials who can notice disorders and step in early. Early diagnosis and early intervention is the way forward. Does she agree?

[Paula Sherriff]

I thank the hon. Gentleman for his intervention. Frankly, a debate would not be complete without an intervention from him. I absolutely agree. When I was speaking to the professional at the Mirfield Free Grammar, she told me that much of what comes through her door relates to eating disorders, crucially in boys as well as girls. Sometimes we continue to stereotype that eating disorders affect only women. The reality is quite different.

As a number of Members have suggested, social media can be a double-edged sword. I will talk about Beat in a moment. Beat does excellent work and has fantastic online resources, as do a number of other mental health charities. However, other sites that we have heard about that encourage people with regard to suicide and their eating disorders can be problematic to say the least.

The Government have made a commitment that, by 2020, 95% of children and young people who are referred with an eating disorder will be seen within one month, or one week if it is considered urgent. That is obviously very welcome, but with 2020 just around the corner I am concerned that, given current workforce and funding pressures, that will be difficult to achieve, or will possibly result in manipulation of waiting time figures. A patient will get a first appointment within the timescale, but any follow-up or effective treatment will still come many months, or even years, after referral. I would be grateful if the Minister would say how it will work in practice.

Although that is all well and good for children and young people, there are still no clear plans for adults with eating disorders. I recently visited a NAViGO service in Grimsby that supports people with eating disorders, and I was struck by how many people who were older than me were experiencing in-patient treatment.

My hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) talked about his constituent Sarah. I have a constituent who was diagnosed with an eating disorder at 16. Owing to the severity of her illness, she was sadly admitted to hospital for a lengthy stretch. On her release, she attended fortnightly appointments with an eating disorder specialist. As her recovery was going well, my constituent decided that she would like to take up an offer of a university place in Manchester, because despite her very difficult illness she had achieved the most fantastic A-level results. She saw going to university as a positive step in her healing and as a way of getting on with her life. The local NHS trust that delivers mental health services in my area informed her that she would have to transfer over to mental health services in Manchester.

Neither my constituent nor her family thought too much about that, as it was not raised in such a way that allowed them to foresee any issues. However, five months on, my constituent is still waiting for the handover to be completed and, sadly, during that time she has suffered a serious relapse and is once again looking at in-patient care. I recently attended the all-party parliamentary university group, and we talked about transition when people go to university, and about mental health in general. We need to look at that in some detail.

Safeguarding Vulnerable Adults: Care Homes

Jim Shannon Excerpts

Tuesday 26th February 2019 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Thank you for calling me, Mr Deputy Speaker, and thank you for being in the Chair for my first Adjournment debate, which concerns such an important matter.

The UK has a world-class national health service, full of the most fantastic doctors, nurses and support staff. It is a testament to our fantastic NHS that, for decades, we have generally seen life expectancy increase across the country. With increasing life expectancy, however, we have seen a growth in degenerative diseases such as dementia. For families living with a relative with dementia, it is an incredibly difficult experience to see a parent, for instance, lose the ability to talk and forget the essence of who they are. You never forget the first time that they look straight through you, having no idea who you are. I am sure that the Minister will extend her sympathies to the families across the country who live with those circumstances day in, day out.

Many families are increasingly reliant on extra care facilities and nursing homes to manage the healthcare needs of their elderly and vulnerable relatives. They will therefore experience the heart-wrenching feeling of visiting dozens of care facilities and wondering if their loved one will be happy and safe there—will the care be good enough? Sadly, my family and I have found out what happens when the answers to these questions is no. While the majority of those working in the care sector are wonderful and deserve medals for the incredible service they provide, there are, as in any industry, those who are not, and who, sadly, prey on the vulnerable.

I am going to now share something that is not at all easy to talk about. Minister, there are some phone calls you never wish to receive, and I can say that one of them is the hushed phone call from a carer who knows your family, who tells you that as a matter of urgency you need to come to the care facility and check on your loved one because they have been hurt. Nothing prepares you for arriving to find your loved one with black eyes, bruises, cuts and blood on their face. And I can tell you, Mr Speaker, that nothing prepares you for discovering that these injuries in fact happened three days previously and nobody called you, no one alerted you, nobody called an ambulance despite the fact that somebody had a head injury, was on blood thinners and is elderly, and with not a single person—not one—having any answers as to how this may have happened or any proof at all as to how this occurred.

My father has dementia. It started very young and affects a part of his brain that is involved with speech. He is fully aware of everything and even has memory, but his days as a university lecturer would be hard to imagine now were you to meet him, as not only does he not speak, but he can only sing in his mother tongue—which I have never heard him even speak in my lifetime. This makes him extremely vulnerable as he is unable to communicate with those who do not know him. As his children, however, my brother and I can understand his body language and his emotions; we know when he is happy, we know when he is sad, and unfortunately we now know what his demeanour is when he is deeply, deeply frightened.

He was found extremely distressed by a carer covered in bloody injuries which would have caused a great deal of blood loss wherever they had taken place. To our horror we were told that he had not left the building overnight, there was no evidence of him having fallen and no other resident had any evidence of injury. Quite unexpectedly, the centre manager suddenly left and not a single person had any excuse for what had happened or why we were not called. Three days—three days—it took for us to receive a phone call, which came in the manner of a hushed call from a carer who was leaving the very next day. She said she was entirely aware that we had not been told and deeply thought that we should know.

As any family would, we complained immediately to Wandsworth Council, which contracts out the care to London Care, which manages Ensham House, which is owned and run by Optivo. I am sad to say that there our nightmare began, and that nightmare is the reason for this debate, for if two young professionals can endure what happened in the following months in pursuit of answers I fear deeply for the elderly in our community, such as the 80-year-old woman who herself is frail, who is caring for her husband with dementia, and who is too fearful to speak out for fear of going through what I am about to describe.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to the Chamber. She and I spoke about it last night, so I had a bit of an idea of what the issues were going to be. I commend her for bringing us her personal story and this exposé of what has happened to her family. Does she agree that the ability of former owners and management of care homes that have received bad ratings simply to operate elsewhere under a new name is not conducive to openness and transparency, and that consideration must be given to introducing further and better regulation of the staff, management and ownership of these homes, which house some of the most vulnerable people in the UK? Unfortunately, we have had similar circumstances in Northern Ireland, and they are heartbreaking for the families. I understand exactly what the hon. Lady is saying.

[Dr Allin-Khan]

I thank the hon. Gentleman for his intervention, and I entirely agree with him. This debate is about safeguarding all our vulnerable adults, including his constituents and all the people up and down the country who want and deserve the very best for their families.

St Helier and St George’s Hospitals

Jim Shannon Excerpts

Tuesday 19th February 2019 Commons Chamber

[Siobhain McDonagh]

My recollection of that particular consultation was that that was really the scorched earth strategy of deciding that St Helier and Epsom were going to close and St George’s would take the strain. I thank God that that never happened, because we could be in an extraordinarily difficult position had it ever happened.

I might sound cynical when I talk about the NHS and its bias against my constituency and against services being at St Helier Hospital, but I have been here several times before. A freedom of information request revealed that those running the programme only distributed consultation documents to targeted areas around their preferred site and to just a handful of roads in my constituency. But my constituents care passionately about their local health services and will not be ignored, and 6,000 local residents responded to the programme by calling for St Helier to retain all its services on its current site.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way. I sought her permission to intervene beforehand because I am always very interested in health issues, and I am here to support her as well. Centralising the health service means that the ill and the vulnerable and pregnant women are expected to travel for miles to get medical assistance. That is totally absurd. Surely the health of the patient must always be put first and foremost.

[Siobhain McDonagh]

I agree with the hon. Gentleman, but it is about not just distance travelled but who is travelling that distance: do they have access to a car, or do they have public transport? The NHS constitution requires that equalities legislation is taken into account, particularly looking at disadvantaged people who are in poor health and how they access services, because they access services differently.

As I said, my constituents care passionately about local health services, and when they responded to the consultation 6,000 of them sent in cards explaining how they felt and saying that they wanted St Helier to retain all its services on its current site. Can you imagine the anger when I found out that their responses had been discounted by the programme? Why? Because they were not on the official documentation—the same documentation that had been disseminated in those targeted letterboxes far away from my constituency.

To the public, the trust portrayed a neutral stance whereby a suitable site across south-west London would be selected for their acute services. To the stakeholders in Belmont, it confessed its desire to move the services to their wealthy area, and to mine, it pretended that the consultation would genuinely seek the views of the public. But as my mum always says, much gets more. I would like to put on record that while I fundamentally disagree with the desire to take services away from my constituents, I do recognise Mr Elkeles’ hard work and dedication in leading St Helier Hospital.

We now fast-forward to the present day and the latest brand, “Improving Healthcare Together 2020-2030”, a programme built upon the unstable and unscrupulous foundation of its predecessors and that once again considers the pros and cons of moving St Helier Hospital’s acute services 7 miles west to Epsom or south to leafy Belmont in Sutton. The programme was launched last summer—they always choose the summer—undertaking an initial public engagement that is expected to transition to a public consultation this coming summer. But just 837 people responded to the public engagement, and that is including hundreds of NHS staff and 169 comments on Twitter or Facebook. That is an utterly abysmal response considering the £2.2 million of taxpayers’ money squandered on the programme already. Does the Minister agree that this is a complete misuse of taxpayer funds at a time when our NHS is under such overwhelming pressure?

This is about more than just the future of St Helier Hospital. My constituents tell me that if St Helier Hospital were to lose its acute services, they would turn not to Epsom or Sutton but east to Croydon University Hospital or north to St George’s. That is a completely terrifying prospect. Before Christmas, my constituent, Marian, was left queueing outside St George’s Hospital with her left leg badly infected, because the A&E was full. And that was the calm before the storm, with St George’s A&E facing its busiest ever week just a fortnight ago. We all remember the winter crisis last year, but the first full week of February this year was 16% higher than last year’s equivalent, with a simply staggering 600-plus visits every single day. This is a hospital that already relies on St Helier as its safety valve. The maternity unit at St George’s had to close temporarily in 2014 and 2015, directing women who were already in labour to St Helier Hospital.

That is why a letter sent in November from the chair of the St George’s trust to those running the programme is completely astonishing. In the letter, the chair expresses her concern that

“there is no formal requirement to take account of the impact on other providers”

when deciding where to relocate acute health services across south-west London. It is hard to put into words just how dangerous that disregard is. I should like to pause briefly to thank the chief executive of St George’s Hospital, Jacqueline Totterdell, for her hard work and tenacity in steering one of London’s largest hospitals at a time of such difficulty.

St George’s is a hospital already under immense pressure. The plumbing, ventilation and drainage facilities are at breaking point, leading to a bid for £34 million of emergency capital from the Treasury. Does the Minister agree that a recent outflow of sewage in the hospital A&E is a clear sign that such emergency funding is justified and, more importantly, urgent? How busy does she think the same A&E would be if the local NHS were to get its way and move St Helier’s major A&E to wealthy, leafy Belmont? Will she step in today and require any proposal to reconfigure health services to wholeheartedly take into account the impact that such a decision would have on all other nearby health providers?

Merton Council recognises the devastating impact that these proposals could have, and I would like to put on record my thanks to leader of Merton Council, Stephen Alambritis, the cabinet member for social care, Councillor Tobin Byers, and the director of community and housing, Ms Hannah Doody, for their unflinching support. It is so disappointing that those at Sutton Council can stand so idly by.

By law, when deciding where acute services should be based across a catchment area of this size, it is fundamental that the level of deprivation and local health needs are accurately understood and thoroughly assessed. So I read from cover to cover the deprivation and equality analysis produced by a range of external consultancy services as part of their £1.5 million programme fee. At a time when the NHS is so strapped for cash, it is extraordinary that my local NHS seems to have carte blanche to employ so many consultants on such extraordinary rates. But even I was absolutely astounded by the monumental gaps in the analysis that these consultants have delivered.

In the pieces of analysis on deprivation and equality, areas that rely on St Helier Hospital are either absent from the documents or actively described as falling outside the catchment area. Take Pollards Hill in my constituency, an area that would be considered deprived in comparison with much of Sutton or Epsom. Wide Way Medical Centre is the largest GP surgery there, and it directs 34% of its patients to St Helier Hospital, but Pollards Hill is deemed to be outside St Helier’s catchment area. Why does this matter? Because if areas that rely on St Helier Hospital are not even considered in the analysis, how can the potential impact of moving acute services from the hospital be adequately assessed? Pollard’s Hill is not alone. The report does not mention Lavender Fields despite almost a fifth of Colliers Wood surgery patients and Mitcham family practice patients being directed or referred to St Helier from the ward.

I urgently brought the gaps in the analysis to the attention of those operating the programme and Jane Cummings, the NHS’s chief nursing officer. I was pleased that everyone agreed that such significant analysis shortfalls would be addressed and rectified.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 19th February 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this. When children’s hospices expand and include facilities for young adults, it can make such an immeasurable difference in their local area. In my area, the Naomi House children’s hospice has opened Jacksplace, which has been such a valuable resource. Hospices should be incredibly celebrated for all such facilities they offer.

[Jim Shannon (Strangford) (DUP)]

Will the Minister take this opportunity to guarantee that the £11 million children’s hospice grant will be protected for children’s hospices, and indeed further increased as a result of the long-term plan to reflect the growing demand and the complexity of care provided by these lifetime services?

[Caroline Dinenage]

Yes. I think this is a really strong signal to clinical commissioning groups about how the NHS values the services provided by children’s hospices—not just end-of-life and palliative care, as I say, but the other respite and outreach services they provide. That is why giving them access to up to £25 million will make an immeasurable difference.

NHS Menopause Services

Jim Shannon Excerpts

Wednesday 13th February 2019 Commons Chamber

[Rachel Maclean]

I thank my hon. Friend so much, both for his work locally and for supporting me in this work in the Chamber and the House. He is an absolutely fantastic campaigner for the menopause and for women.

Psychologically, none of us likes to be reminded that we are growing old. For women, however, the menopause provides irrefutable evidence that our biological clock has ticked. While men can, and do, continue to reproduce into their old age, we cannot. With that loss, we face a grieving process. Our species has evolved to reproduce itself, and women’s bodies have evolved to carry out childbirth and child-rearing. Aeons of our cultural norms have been built upon that basic and irrefutable fact. Despite advances in all areas of medicine, I do not see men being able to conceive children or breastfeed any time soon, so the loss of those capabilities comes weighted with deep-seated and unexpected emotions. At the same time that we are attempting to grapple with those emotions, we find ourselves beset with a huge laundry list of symptoms and facing at best, indifference and ignorance, and at worst, downright hostility, mockery and discrimination while we attempt to help ourselves.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing the debate. Like the hon. Member for Walsall North (Eddie Hughes), I have much interest in this, not only because it involves health issues that I am responsible for, but because sometimes things are pretty close to home. Does the hon. Lady not agree that the support that is needed for women who are going through tremendous changes in their bodies is not readily and sustainably available at GP surgeries, and that funding needs to be allocated to support groups, like the ones that the hon. Lady and the hon. Gentleman referred to, to ensure that the mental and physical health of ladies going through the menopause is readily available? That is very important.

--- Later in debate ---

[Rachel Maclean]

I thank my hon. Friend again for that really good point. In fact, menopausal women are the fastest-growing demographic in the workforce. It is vital, therefore, that employers step up and produce menopause policies to help women going through this process.

There are many ways in which society can better support menopausal women, but we must look also for ways in which menopausal women can better help themselves. Of course, education can help. We can raise awareness of these issues in numerous ways—for example, through sex and relationships education in schools. We teach young girls about reproduction and periods, about contraception and relationships, and we ought at that stage to educate them about what happens in the menopause.

Employers also have an important part to play and can introduce supportive policies in the workplace, and I am pleased that many large employers are starting to lead the way in this respect. The best known local employer I have worked with is the West Midlands police, who are introducing creative and groundbreaking policies. Having spoken to women who have worked with them to introduce those policies, I know they faced considerable barriers when they first started to bring these conversations into the workplace—this very traditional, male-dominated environment—and yet they persisted, and now they find that their events and support groups are oversubscribed and that men really want to help and get involved to support their female colleagues.

[Jim Shannon]

I mentioned in my earlier intervention the importance of access to GP surgeries. Every lady who has this problem goes to her doctor. That is a fact. At that stage, there is an opportunity to address the issue. I hope that the Minister will respond to this point—she always does respond very positively—because there needs to be some extra assistance in GP surgeries to help the ladies whenever they present with these problems.

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on securing this debate on health services and the menopause, and I want to start by celebrating the fact that we are discussing this subject. For too long the things that only affect women have been taboo; they have been brushed under the carpet—they have not been discussed in this place. One of the most magnificent of the many great side-effects of having a more gender-equal place is that we begin to discuss these subjects and those last taboos get addressed properly. It is wonderful to hear and see the men present in this Chamber who also care passionately about this subject; that must be celebrated too.

My hon. Friend has been a passionate and highly effective campaigner for improved awareness of the menopause and better support for women who are dealing with some of the difficult symptoms. I am very grateful and supportive of her work on this issue; in my eyes she is an absolute hero. I believe it is vital that we provide effective support and treatment for women with menopausal symptoms. It is of the utmost importance that we continue to work to improve that and to tackle the misconceptions attached to the menopause.

My hon. Friend raised the issue of HRT and expressed her concern that some GPs are not prescribing or recommending it to women who need it. No two menopauses are exactly alike and GPs play an important role in ensuring patients are given treatment that is appropriate to them. It is worth bearing in mind that the menopause is a natural stage in a woman’s life, and that many women will experience the menopause without troublesome symptoms or the need for treatment. Where symptoms do arise, HRT can be very effective in relieving them, and GPs should give menopausal women information about HRT as a treatment option, highlighting its risks, if they see that there are any, and its benefits. However, every patient is different and HRT might not be suitable for everyone. It is not the only treatment for menopausal symptoms, and GPs should also, where appropriate, talk women through all the non-hormonal and non-pharmaceutical treatments that are available.

My hon. Friend is right to say that there has been real confusion in the past about the safety of HRT. Concerns were raised in the early 2000s, as she mentioned, when a study said it was associated with an increased risk of breast cancer and heart disease. As a result, many women were advised by their doctors to come off HRT and the number of HRT users in the UK fell significantly. I cannot stress strongly enough that, as my hon. Friend has noted, the evidence base has since become clearer and the NICE guidance on the menopause is clear that HRT is a perfectly safe treatment in the majority of cases, and in most cases there is a far lower health risk in taking HRT than in drinking a couple of glasses of wine every day or in obesity, as my hon. Friend said.

The NICE guidance on the menopause also provides GPs with advice on how to recognise symptoms of the menopause. This guidance has helped prevent misdiagnosis, and my hon. Friend spoke very powerfully about how sometimes menopause can be mistaken for depression, which is incredibly worrying. Improving treatment of the symptoms of the menopause is also important.

We are also taking a range of other actions to improve support for women experiencing menopausal symptoms. This includes the work of the royal colleges, which of course play an important role in the education, training and professional development of healthcare professionals who treat women with menopausal symptoms. The Royal College of General Practitioners has produced a toolkit that includes learning resources for GPs on diagnosis and management of symptoms of the menopause. In addition, the Royal College of Nursing, in collaboration with the British Menopause Society, has produced a guide providing information for nurses who wish to become specialists in the menopause. That is very important, too. The Royal College is also aiming to develop a GP specialty that focuses on women’s health, which will be warmly welcomed.

Correct diagnosis and treatment of symptoms of the menopause are important, but we also have to focus on improving wider awareness of the menopause. An important part of this will be to have more open conversations around the menopause, so that we can start tackling the taboos that are attached to it. Taking this wider, bigger-picture approach is vital, given the huge impact that the menopause can have on all parts of a woman’s life.

In raising awareness and tackling taboos, we need to ensure that we reach out to all demographics, including boys and men. I cannot help thinking that if a similar hormonal transition affected men for an average of four years in the second half of their life, we would never hear the end of it—[Interruption.] Present company excepted, of course. As it is, the menopause has become something of a taboo, and we have to get over that. That is why it is so incredibly faith-restoring to see these incredibly liberated and forward-thinking gentlemen in the Chamber tonight, including my hon. Friend the Member for Walsall North (Eddie Hughes), who has talked about the menopause café that he runs. He should be championed for that. I was also pleased to see that the debate that was held on world menopause day last October was called by a male MP. These men are champions, in my eyes, and they deserve to be celebrated.

As my hon. Friend the Member for Redditch mentioned, education is absolutely key to promoting awareness and understanding of the menopause. The Government are making relationships education compulsory in primary schools and relationships and sex education compulsory in secondary schools. The underpinning focus in these subjects is to equip young people to develop positive attitudes to health, relationships and wellbeing. Schools will then have a really good opportunity to improve pupils’ understanding and awareness of the menopause.

Hon. Members will be aware that women represent 51% of the UK population and 44% of our workforce. They play a vital role in the nation’s health, but they do not always receive the most timely or appropriate healthcare. My hon. Friend mentioned the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is the Minister with responsibility for mental health, inequalities, and suicide prevention. She is doing sterling work on this issue, and she has set up a women’s health taskforce. This taskforce will work to ensure that women receive timely and appropriate care in relation to a whole range of issues, and as part of its upcoming early work, it will consider the menopause.

This work will be informed by a collaborative discussion that will be led by the brilliant chief medical officer and include the Royal College of Obstetricians and Gynaecologists, a number of academics who work in menopause research and GPs who specialise in the menopause. These discussions will feed into the taskforce’s wider objectives: to empower women to speak more confidently; to raise awareness and break taboos around women’s health problems; and to improve the access, quality and experience of care for women. I hope that that will help to address some of the important issues that my hon. Friend has raised today, and I am sure that my ministerial colleagues in the Department of Health and Social Care will be absolutely delighted to work closely with her on the taskforce’s developing work around the menopause, because she has done such sterling work in this area so far.

We need to ensure that workplaces provide the necessary and appropriate support for women. A recent study found that 41% of women aged 50 to 60 said that the menopause had affected their job, but that 70% did not tell their employer about their symptoms. This demonstrates the work that needs to be done to move beyond shame and silence to an open conversation about the menopause, because half the population will go through it. Giving better support to those women in work is not only right but fundamentally good for the economy. Women over 50 are now one of the fastest growing groups of employees. They have invaluable skills and experience, which means that they are incredibly difficult to replace. We should be looking to support them to stay in work whenever we can.

I am particularly proud to be responding to this debate tonight not only because I am hurtling very fast towards the menopause myself but because, when I was Minister for Women and Equalities, I chaired the very first parliamentary roundtable on awareness and taboos around the menopause in the workplace. This was the first ever meeting in Parliament that brought together important stakeholders and interested parties to discuss this important issue. We heard some incredible evidence. I remember one lady telling us that she had had to leave her workplace because all she wanted was a desktop fan to help her deal with the hot flushes, but the company would not let her have one and so lost an employee with incredible experience and huge amounts of skill, which just makes no sense at all.

[Jim Shannon]

I thank the Minister for her positive response. There is an old proverb that a problem shared is a problem halved, and the Minister has clearly indicated a method of doing that. I encourage her to get that message out across GP surgeries, education and all the relevant bodies.

[Caroline Dinenage]

The hon. Gentleman is an enlightened man. The work that we did at the very first roundtable led to an evidence review that was published in 2017, which talked about raising awareness and about the effects on women’s economic participation. The review led to the Women’s Business Council developing a toolkit to enable employers to support their employees more effectively, and I think we can all agree that that can be nothing but a good thing.