Universal Declaration of Human Rights and UN Convention on Genocide

Debate between Jim Shannon and Lyn Brown

Thursday 7th December 2023 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

I am very grateful to be called, Ms McDonagh. I believe this is the first time that I have served under your chairship; I hope it will not be the last. I am also very grateful to my hon. Friend the Member for Rochdale (Tony Lloyd) and the hon. Members for Henley (John Howell) and for Strangford (Jim Shannon) for securing the debate. My hon. Friend the Member for Rochdale and the hon. Member for Strangford spoke with great knowledge and passion, and I am grateful to them. I also want to put on record my best wishes to the hon. Member for Henley for a speedy and full recovery. Before I start, I would also like to thank in particular Kate Ferguson of Protection Approaches, who works with Members across the House. She is a real source of huge support on how we can use our tools more strategically to prevent atrocities.

The 75th anniversaries of the universal declaration on human rights and the genocide convention are this weekend, and I want to start by noting what an achievement they were. The world came together after the devastation of the second world war and the utter unprecedented horror of the holocaust, and committed to action. I know we all believe that working together internationally against genocide and human rights abuses is no less essential today.

As we have heard, right now in Sudan there are massive numbers of people under threat. The past weeks and months have brought more and more evidence of mass killings, rapes and the systematic forced displacement of civilians. The evidence is particularly strong that the Masalit communities are repeatedly—repeatedly—targeted for atrocities. Right now, El Fasher in North Darfur is in desperate peril. Civilians in Khartoum continue to be killed and denied humanitarian access, and the violence is spreading.

I truly welcome the United States’ determination of war crimes, crimes against humanity and ethnic cleansing, and in particular the recognition that arms and funding to the military faction fuels the horror, not matter what the source. I believe the US determination builds on work in this House and in Government, where we have worked together to shine just a fraction of the light that Sudan’s crisis requires. As we warned before the summer, permanent partition or even state collapse in Sudan is an increasingly serious risk. The scale of atrocities that could result, in addition to the many already committed, is simply enormous.

Despite the severity of the humanitarian crisis, the UK, as the UN Security Council penholder on Sudan, is now presiding over the closure of the UN’s Sudan mission. So far, the international community has not had enough co-ordination and commitment for the mediation in Saudi Arabia or the African Union’s leadership to have an impact. The situation is utterly bleak. It is joined, as we know, by the sheer horror in Gaza that we see day after day on our screens, where children are being killed in their thousands as their homes are bombed; where civilians are being kettled into so-called safe zones that are anything but; and where the siege continues and humanitarian access is denied despite the tireless efforts of colleagues.

[Ian Paisley in the Chair]

However, we cannot just sit here and wring our hands. I believe that we cannot be content with symbolic acts of condemnation, and we cannot let petty political divisions take hold—not when it comes to Sudan, Myanmar or Gaza. We must not allow ourselves to be distracted from what we can actually do, because, as the raw ongoing experiences of Sudan teach us, the way in which we work against atrocities and support universal human rights needs to adapt. Let us face it: we live in a more polarised world than in recent decades, and it is far more complex and fragmented than in the 1950s. The relationships that we need to navigate are much larger in number and massively diverse in nature. Misinformation and hate speech spread at a speed and scale that we have never seen before. That means that we must approach these questions from a place of humility and respect, recognising that we are not always the best people to lead; that we do not always have the answer; and that trust is hard-won and easily lost. We must recognise that our international reputation has been damaged over recent years and look to renew it.

Sadly, many of the tools of the multilateral system, such as Security Council resolutions and UN sanctions, simply are not as accessible as they once were. To be frank, as we know, that is sometimes because Russia sees chaos, destruction and division as being in its interest. However, in other cases it is much more complicated than that.

[Jim Shannon]

I am sorry to interrupt the hon. Lady. I recall that this morning I got a message—actually, a video —on my phone. The message was clear: 120,000 Christians in Artsakh—I hope that is pronounced correctly—in Armenia are under threat. They have no gas, water or electricity; they have no hope, and they are being butchered by an Islamic regime sponsored by Russia. I will make a plea for them, if the Minister is listening. That is another example of genocide against my brothers and sisters.

[Ms Brown]

Certainly. I hear the hon. Gentleman’s plea, and I am sure that the Minister will be able to respond to that with knowledge and compassion. I argue that the causes I spoke about earlier, and which we have all spoken about today, make the challenges of this agenda so much more challenging, not less—and more necessary.

It is now more important to support accountability through the International Criminal Court, including in conflicts we see on our screens day in, day out in Ukraine, Palestine and Israel. It is more important to work with civil society and protect human rights defenders and journalists. Most importantly, in a world that seems ever more dangerous, the prevention duty in the genocide convention is more relevant, not less. If we are smart and strategic, we can do a lot to work against the perpetrators, enablers and drivers of atrocities. The UK has powerful strengths that we can deploy, including our still-expansive diplomatic network and national expertise in legal and financial services.

As my hon. Friends the Members for Rochdale and for Putney (Fleur Anderson) have said, we need to raise the alarm early, based on more extensive mapping and monitoring of atrocity risks and stronger links to civil society organisations. We need to work with our partners to bring together information about the networks that fuel atrocities, rapidly build awareness of patterns of rising violence and share evidence of responsibility. We then need to be proactive by using that greater understanding of those driving the violence to press armed groups towards de-escalation and mediation and to cut off external backers’ money to perpetrators.

We need to empower our excellent in-country diplomats to support the community-level leaders and human rights defenders who can make the difference when it matters most to prevent an escalating crisis. That is so rarely about big, flashy money; it is about rapid, quiet support for those who can calm tensions, provide credible alternative narratives in place of incitement and, if the worst comes to the worst, document the violence so that perpetrators can be held to account. It surely goes without saying that preventing a crisis avoids the vastly bigger costs of humanitarian aid, forced migration, emergency evacuations of UK nationals and the loss of development opportunities, which are shattered for years to come. And it saves lives.

What I am saying is that we need a prevention-first approach. The White Paper makes genuine, welcome progress on that, but we now need consistent leadership to turn words into reality over the coming years. As my hon. Friend the Member for Rochdale said, there are serious concerns about Rwanda—internally in terms of human rights and externally via the evidence of atrocities by the March 23 Movement in the DRC. That has been raised in FCDO, in addition to being raised multiple times by colleagues on both sides of the House. I gently say that it may damage our relationships with many partners if there is a suspicion that a narrow migration partnership, which the Opposition do not support, might be getting in the way of consistent UK support for human rights and atrocity prevention.

But it is not all bleakness and horror. If we work together and are strategic, we can help to slow the increasing violence across the world. To give just one example, there is hope that the draft convention on prevention and punishment of crimes against humanity will continue to make progress with UK support. Perhaps—just perhaps—the convention might add strength where some argue that existing international laws fall short. Perhaps there will be more legal and diplomatic clarity in future about the intentional denial of access to food, water or medicine in internal conflict. Sadly, that has been evidenced in recent years in Ethiopia and now in Sudan.

We need to consistently support progress where we can. A safer world, where rights are protected for all, is a world with far fewer people in desperate need of humanitarian aid. It is a world where the politics of division and hatred is harder for malign actors to exploit, and it is a world with more opportunities and security for the UK—a world where we do not scrabble from crisis to crisis, but where our long-term international partnerships can flourish for mutual benefit. Surely we want to live in a world where the high ideals of 75 years ago are truly honoured and implemented, and surely that is worth fighting for, with strategic thinking and with passion.

Religious Minorities in Nigeria

Debate between Jim Shannon and Lyn Brown

Tuesday 18th April 2023 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is an absolute and genuine pleasure to serve under your chairship, Ms Nokes. My thanks go, as ever, to the hon. Member for Strangford (Jim Shannon) for securing this debate. I will echo much of what he said.

Nigeria is an important partner for the UK. We have such vibrant connections through our diaspora communities, thriving trade and cultural links. We have a clear, common interest in reducing insecurity across the Sahel and west Africa, and in supporting democracy in a region where military coups have sadly become frequent. As we heard in the debate last June, the days when religious violence was largely about Boko Haram and concentrated in the north-east are long gone. Violence and kidnappings connected to religious and ethnic differences are now common in the north-west, the middle belt and parts of south Nigeria too.

Much of that violence is utterly horrific, including the attack on St Francis Catholic Church in Ondo state. Today we remember the victims of that terrorist atrocity: 41 innocents killed during a Pentecost mass. We express again our solidarity with the people of Nigeria for those terrible losses. The fact that the church was filled with worshippers again on Easter Sunday demonstrates the inspiring resilience of that community. So many communities right across Nigeria are showing that same resilience, and a true commitment to peace and working together across differences.

Reports suggest that increased activity by Nigeria’s security forces in the run-up to the elections led to a decrease in killings and kidnappings, but clearly the violence has not stopped. Just two weeks ago, on 5 April, at least 46 people were killed in conflict between farming and herding communities in Benue state in the south-east. Many attacks by armed groups are accompanied by mass kidnappings for ransom, with hostages subjected to horrific brutality. Villages are emptied as people flee, putting even more humanitarian pressure on a country where over 3.1 million people are displaced already.

Some of the violence is clearly targeted at Christians, while in other cases the motivation is less clear. It could be financial gain from ransoms, land seizure, revenge or a political dispute. Many victims of violence by armed groups in Nigeria are Muslim and from many ethnic groups. It is a really complex picture. We must be careful, because generalisations could fuel dangerous narratives about a religious war. As we all know, that can only play into the hands of extremists.

In last year’s debate, I made it clear that greater priority and a change in focus is needed for our security partnerships with Nigeria. We need to better complement efforts to provide security to communities across the country, and our partnership needs to work in harmony with regional efforts to tackle the cross-border drivers of insecurity in Nigeria. We need to understand how interlinked security problems have been growing across the wider region, which means the Sahel and, increasingly, other coastal west African states, including our Commonwealth siblings Ghana and Togo, as well as Côte d’Ivoire and Benin. Without concerted action, insecurity may increase further, so I hope that the Minister can tell us today about the work being done across those borders. What are we doing to tackle the supply of weapons to armed groups? How are we supporting peacebuilding between pastoralist and agricultural communities? I would be grateful to know what progress the Minister thinks is being made on the Accra initiative, and whether she knows of any discussions about future Nigerian involvement in the initiative.

[Jim Shannon]

The hon. Lady is right to highlight the issue of weapons. My understanding is that that part of middle Africa is awash with illegal weapons, which supply many terrorist organisations across the middle of Africa, as well as in the north and south. Could the Minister say what is being done to try to address that?

[Ms Brown]

I will just say to the Minister that I can only imagine what it is like to sit there and face questions she was not expecting, so I am happy to have written responses to any question to which she does not have the answer at her fingertips.

In the past year, there have been repeated reports of human rights violations by Nigerian armed forces, including extrajudicial killings and mass forced abortions, despite our security partnership’s engagement on human rights. I hope that the Minister will help us to reflect on the lessons that have been learned, and I would be grateful to know if there is a date yet for this year’s security partnership dialogue, and how we are navigating the difficulties caused by the contested election. As we know, religious freedom in Nigeria is not just about armed groups; state institutions can also bear responsibility. Last April, Mubarak Bala, president of the Humanist Association of Nigeria, was sentenced to 24 years in prison because of blasphemous posts on Facebook. I hope the Minister can update us on the latest developments in Mr Bala’s appeal.

Sadly, the massive cuts to international development funding will have had an impact, and will limit support for new programmes where the Nigerian people need them most. Bilateral aid to western and southern Africa has fallen from £1.12 billion in 2019 to just £345 million in the last financial year. It is a scandal. Thanks to incompetent and uncontrolled Home Office spending, our aid budgets will fall even further to just £256 million across the whole of western and southern Africa. A cut of almost 80% in just five years will clearly block our ability to respond.

But let us face it: the problem is not just the lack of international aid. Sorting this out requires governance that responds to the Nigerian people’s needs and demands. Sadly, turnout in February’s presidential election hit a new low, and with legal challenges ongoing, the process is not yet complete. I strongly welcome the commitment of the candidates who are challenging the presidential result to rely on only the courts. While that legal process continues, we need to engage with all political forces and civil society to inform priorities for our partnership over the next years.

In February, this Opposition joined the Government in supporting sanctions against anyone who organised to disrupt peaceful, fair and free elections. There have been credible reports of violations, both in the presidential election on 25 February and the gubernational elections on 18 March. There were several documented incidents of violence around polling stations during the presidential vote and still more reports of violence and intimidation aimed at voter suppression on 18 March.

The issue is wider still: the technologies that were supposed to provide transparency and credibility failed on a huge scale. That has understandably led to even greater distrust in the electoral system from Nigerian voters. The UK provided support for these systems, so, surely, there are questions to be answered about why they failed.

On sanctions, I say very gently that the Government’s record on the killings at Lekki, where no action was taken despite calls from across this House, does not inspire huge confidence. Although I know the Minister cannot comment on any specific sanction designations, I hope she will confirm that the Government are prepared to back their words with action, because what happened in the Nigerian election matters for religious freedom and for security in Nigeria. It matters because incitement to hatred and violence based on identity was used as a political tool, but equally, if the Nigerian people lose trust in their Government, I fear the violations we are discussing will only worsen. It is clearly in the UK’s interest to support security, human rights for all and an inclusive, prosperous and sustainable economy in Nigeria.

Nigeria’s path forward is critical for the future of the region, so I hope that the Minister will set out how she will secure the stronger partnership, backed by long-term commitment and resources, that the UK and the people of Nigeria so urgently need.

NHS Hysteroscopy Treatment

Debate between Jim Shannon and Lyn Brown

Monday 31st January 2022 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

I am, frankly, very disappointed to have to be raising this issue again in this House. This is the ninth time I have spoken about this, and it is more than eight years since my first speech on this topic. However, the problem of pain and trauma caused during hysteroscopies has not gone away. I want to pay tribute to the Campaign Against Painful Hysteroscopy, who do so much to let women know that they are not alone, that their experience has not been singular, that they were not making it up and they were not hysterical; they were experiencing great pain and discomfort. That campaign offers comfort and a productive outlet for their utterly justifiable anger. My hope is that this Minister will not only take this issue away, but will commit today to getting action at a national level, because it is a true scandal that these horrific abuses are still taking place. Let me be really clear with people. Every time I speak, I have new stories, because women hear my speech as they reel from fresh abuses and they get in touch. So all these stories that I am going to recount today have happened since my last speech on this issue.

I will start with the story of Jane, who had a hysteroscopy late last year. Jane had been warned by her excellent GP that the specialist might attempt to talk her into a hysteroscopy without anaesthetic, and that she had the right to insist on proper pain relief. After all, she has several well-recognised risk factors for pain during hysteroscopy, including endometriosis, a tilted uterus, and never having had children. Fully aware of that, Jane received a letter for an appointment about the results of an ultrasound scan she had had. The letter said nothing about a hysteroscopy, and nothing about her risks or her right to anaesthetic, so she went along expecting simply to have a discussion with a consultant about the results of the scan. But when she got there, she was informed that the consultant wanted to do a hysteroscopy there and then. She said immediately she wanted a general anaesthetic, and explained that she had had terrible pain from similar procedures in the past. Shamefully, the consultant’s response was to laugh in her face and say

“if we gave a general anaesthetic to every woman who had a hysteroscopy the queue would be a mile long”.

To laugh at a woman in distress in that position, I find abhorrent.

Jane was scared. She shook but she felt she had no choice but to comply. She told the doctor and nurse what she had heard about the pain, but they told her not to believe everything she read. She told me that

“as soon as the speculum went in I felt immense pain that was absolutely unbearable...the doctor was having difficulty finding the opening to my cervix so twisted the speculum and dug around, which caused indescribable pain, I felt I might pass out, I had tunnel vision”—

and she was “shaking and hyperventilating.”

At that point, thank heavens, the procedure was stopped but, unbelievably, the doctor said that he simply did not understand why Jane was in so much pain and causing such a fuss, which only worried her more, because it increased her concern that she had cancer. Even after all that, the doctor was still unwilling to consider a proper anaesthetic. Instead, he prescribed a hormonal pessary and suggested that she come back for another go in a fortnight.

Jane was in a fog. She does not remember anything other than getting home and curling up on the sofa, shaking with shock. She has relived the experience over and over, unable to move on because of the threat that she would have to go through it all again without pain relief. She has had trouble sleeping and has had to take time off work because she cannot concentrate. Understandably, Jane believes that she has post-traumatic stress disorder. She told me that she was actually more afraid of having another brutal experience than she was of dealing with possible cancer. How much will the late detection of cancers resulting from this fear cost our NHS and our families? I emphasise to the Minister that this is not major surgery; it could be essentially painless if only proper anaesthetics were offered.

The last I heard, Jane will now have a hysteroscopy with a general anaesthetic. I am praying that she does not have cancer, because if she does, the months-long delay caused by her mistreatment and the callous attitude of that doctor could be deadly to her. What estimate have the Government made of the added cost of failed hysteroscopies that must then be repeated with anaesthetic? Jane is not alone in her experience and in having understandable distrust of the NHS and doctors as a result of her trauma.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on her speech. I was there the last time that she brought this issue to the House, as I am tonight, because my wife has been through the experience that the hon. Lady referred to. As a result, I think it is important that I am here to support her not just for my wife, but for every other lady across the United Kingdom. Pain relief is a way of providing much needed reassurance for women who are having hysteroscopies. This is a potentially life-changing treatment and women must be enabled to be as comfortable as possible—I see how important that is. Some 35% of the women who undergo anaesthesia-free hysteroscopies reported severe pain. Does the hon. Lady agree that the pain medications and anaesthesia must be readily available for those who need it? No one should have to live in this day and age with severe pain that cannot be taken care of.

[Ms Brown]

I agree with the hon. Gentleman and I am grateful for his intervention. I know he has been in these debates with me, and he makes the same point: no woman should have to go through this. No woman should be held down while procedures happen because they are screaming with pain and they want the pain to stop.

Another woman who contacted me about a hysteroscopy that took place last year told me that she had never experienced so much pain—not from a hip operation, nor from having her spleen removed. As a result of her traumatic experience, she now has anxiety and has been prescribed tablets by her GP just to help her function with the day-to-day. Like Jane, she is losing sleep and no doubt her broader health has been harmed by this. She does not know whether she has cancer, but she told me that she is now too scared to go to the hospital for anything.

There are so many stories that I could have told today. I am sent so many of them, despite the fact that the issue does not get a huge amount of press. Women who experience this are seeking out me and the charity I work with to tell us about it. If there were more publicity, more women would come forward. I really hope that the Minister understands that this is an issue of patient safety, but also an issue of common decency. It is an issue of confidence in the medical professions and the NHS, and it will be costing us all, both in money and in lives, because problems simply are not being caught early enough.

Eye Health and Macular Disease

Debate between Jim Shannon and Lyn Brown

Tuesday 11th January 2022 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.

I thank the hon. Member for Strangford (Jim Shannon) for securing the debate on this neglected topic. Not for the first time, my comments will echo those of my right hon. Friend the Member for Hayes and Harlington (John McDonnell), because today I will focus on the damage that refractive eye surgeries can do to health. In particular, I would like to talk about my constituent, Darren Clixby.

Like many of us, Darren had lived much of his life needing glasses or contact lenses for short sight. As many people have, he heard the messages about laser eye surgery, and its promise to make life easier and better. He also heard the statistics that are bandied about regarding the rarity of serious complications, so he paid his money and went for it in January 2009, but I am sorry to say that the damage immediately after the surgery was awful.

Darren was in tremendous pain. He could not open his eyes at all until the following day and, when he did, his vision was unrecognisable. It was filled with sunbursts coming from light sources, with halos arounds them, with images that overlapped and with many floaters, which are small objects that persistently stay in the vision no matter where someone looks; I have loads of them in my eyes.

Having such damaged vision was distracting, disorientating and very distressing. Darren could not function. He had been told that this was merely a temporary effect and that it would go away after surgery, so he took sick leave and he persevered in that hope. The weeks passed, then the months, and the problems with his vision simply did not go away. Understandably, Darren became increasingly distraught, anxious and depressed. At check-ups, he was told time and again that it was temporary. He was fobbed off with steroid eye drops, which did nothing.

He was then offered another procedure with the same company, using an alternative refractive surgery technique, then another, via a private referral to Moorfields Eye Hospital, and then another. Darren has now had five separate refractive eye surgeries, four of which were to correct the damage of the first. None of these operations have helped. In fact, Darren believes they have just made things worse.

All of this time, Darren’s mental health was deteriorating. He found his work as a solicitor increasingly impossible because of the psychological damage that resulted in a diagnosis of severe depression and anxiety, which remains 13 years on. He resigned from his job and endured 18 months out of work. Even now, after getting a new legal role, he has found it difficult to continue and he had to resign 18 months after starting that job. Eventually, in 2012, Darren had to stop the process of repeated surgeries, and disengage to protect what was left of his mental health. It has taken him many years to come to terms with what has been done.

[Jim Shannon]

I thank the hon. Lady for sharing what surgery can be like. I have a diabetic constituent who asked a consultant if laser surgery would be appropriate. Unfortunately, as a result of that surgery he lost his eyesight in its entirety. Today, he has no sight in either eye. When it comes to surgery, the hon. Lady is absolutely right and I thank her for the reminder that it does not always work. People need to be careful and aware of that.

[Ms Lyn Brown]

Darren now believes that there is nothing that can be done significantly to repair the damage to his sight. He has uncomfortable, dry eyes every day of his life, which become far worse after reading or concentrating for long periods. He cannot see clearly in low-light conditions or drive after dark. Even crossing the road can be dangerous because it is hard to judge the distance between cars.

Darren believes that he was not fully informed about the risks before his surgery. He has no trust in what little regulation or self-regulation exists via the General Optical Council and the General Medical Council. This was a private, elective procedure that Darren paid for. Surely to heavens, the company that performed the surgery should be responsible for the best possible aftercare, and for making it right. In 2017, Darren again contacted the company responsible for the original surgery. It was made absolutely clear that it would offer him nothing. Effectively, it told him to go away, to stop being a nuisance and to stop getting in the way, frankly, of it making more money.

As always, the NHS has been left to pick up the pieces after poorly regulated private medicine has failed. I ask the Minister how much is this costing the NHS across the country? It would be good to know. Does she have any information to hand on that? We need to create a system where patients are genuinely informed about the real risks; a system where there is proper recourse to a regulator when things go wrong, and where private companies are held responsible for their failings and the cost.

NHS Hysteroscopy Treatment

Debate between Jim Shannon and Lyn Brown

Thursday 24th September 2020 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

I am really grateful to you, Madam Deputy Speaker, and it is really good to see you.

This is the eighth time I have raised in this House the way women are treated by the NHS when they need a hysteroscopy. I have always had a sympathetic hearing. Throughout the years, I have given voice to an ever-growing group of courageous women, the Campaign Against Painful Hysteroscopy. I am sad to tell the House that the issue has not been resolved. Far from it. Women are still being denied the right to provide informed consent and having their pain ignored while a procedure is performed, and some suffer lasting trauma as a result of a hysteroscopy.

For those who do not know, a hysteroscopy involves a camera probe being inserted into the womb, past the cervix. Sometimes, a sample will be cut away from the woman’s womb for examination—it will be cut away from her womb. A hysteroscopy can be an important tool for diagnosing the causes of common problems, such as unusually heavy periods, unexplained pain or bleeding. It can enable life-saving treatment to begin, or provide invaluable reassurance that a problem being experienced is not caused by cancer.

It is true that for some women, sometimes, a hysteroscopy causes only minor discomfort, but for others it causes agony and a sense of violation, because hysteroscopies are often carried out in NHS hospitals with little or no anaesthetic. Frequently, women are simply advised to take paracetamol or ibuprofen for the pain.

[Jim Shannon (Strangford) (DUP)]

First, may I say how nice it is to see the hon. Lady back in the Chamber? I am very pleased to see her.

Someone very close to me is going through this particular thing at the moment, so I understand exactly what the hon. Lady refers to. Does she agree that some women’s experience of this treatment is truly extreme, and that pain medication must be made available for those who need it, as opposed to stopping and sometimes redoing the procedure?

[Ms Brown]

The hon. Gentleman is absolutely right. It is a delight to see him in his place, too. I will come to the lack of pain relief for women and just how damaging that can be for them, not only in that moment but often for their ongoing healthcare, because it creates fear and a barrier.

Massively improved information leaflets have been produced by the Royal College of Obstetricians and Gynaecologists, in collaboration with patients. I am also pleased to note that the NHS website, which I quoted from in the last debate, has now been changed to recognise that some women experience severe pain and a general anaesthetic should be an option. However, many women having a hysteroscopy are still not being given this essential information. They still are not having the risk of severe pain discussed with them properly, and they still are not having the option of a more effective anaesthetic offered freely. In truth, these women cannot give genuinely informed consent, and therefore their rights as patients are being violated.

Telling the story of your trauma is very difficult. The excellent women at the Campaign Against Painful Hysteroscopy are still a relatively small group. Despite that, the campaign has collected 1,500 personal accounts of painful hysteroscopy. Previously in this House, I have told the stories of women who have been held down as they tried to stop the procedure, who have collapsed from shock, bleeding in hospital car parks afterwards, and who have been criticised by doctors for their supposedly low pain thresholds because apparently “most women are fine with it”. Today I will raise the voices of three very recent hysteroscopy patients, because I want the Minister to know that this barbarism is still taking place.

Rebecca had a hysteroscopy last year. She was given no information before her appointment, received no warnings about severe pain and was not offered sedation. Fortunately, Rebecca had had a similar painful procedure before, so she asked for pain relief and was offered a local anaesthetic injected into her cervix. That, in itself, was painful, but she hoped beyond hope that it would be worth it, and the doctor reassured her that the procedure had been massively improved. Instead, Rebecca said:

“As the probe was inserted I struggled to believe how severe that pain was. As the biopsies were taken… I could feel my insides being cut away and I had absolutely NOTHING to address the agony of it all! I was trying not to scream, very close to vomiting and fainting. In trying to contain my screams I couldn’t speak—if I had, the screams would have ‘escaped’ and I knew that they would be deafening. The procedure seemed to go on and on. It was barbaric and, as I hadn’t been given any warning, I felt panicked and unsafe.”

After they were “finished” with her, in her words, she says that no one cared that she felt faint, was close to tears and was struggling to walk. Rebecca tells me she felt conned, and not treated as a human being but

“an object to cut bits out of”.

Depersonalisation Disorder: NHS Treatment

Debate between Jim Shannon and Lyn Brown

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.

NHS: Hysteroscopies

Debate between Jim Shannon and Lyn Brown

Tuesday 11th December 2018 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I beg to move,

That this House has considered NHS treatment of patients requiring hysteroscopies.

It is an absolute pleasure to serve under your chairmanship, Mr Howarth. We know that hysteroscopies save lives, but all too often they cause excruciating pain and humiliation because some of the women who need them are not treated with the dignity, respect or even humanity that they deserve.

As hon. Members will know, a hysteroscopy involves the insertion of a camera into the womb, past the cervix, to look for abnormalities and potentially enable a surgeon to remove them. It can be used to rule out a diagnosis of cancer when women are experiencing heavy periods, unexplained bleeding, repeated miscarriages or difficulties in becoming pregnant, and it is a core part of the treatment for debilitating conditions such as fibroids and health risks such as polyps in the womb. However, for some women patients it causes severe pain, a sense of violation and lasting trauma.

The NHS website states:

“A hysteroscopy is not usually carried out under anaesthetic… Taking painkillers such as ibuprofen or paracetamol…can help reduce discomfort after the procedure.”

Unfortunately, many women experience severe pain during hysteroscopy. It is usually done with little or no anaesthetic, and many women are told nothing to prepare them for the agony that awaits. I have passed the Minister many dozens of anonymous cases from women who have experienced terrible pain at the hands of NHS surgeons and were ill-informed or misinformed about the pain risks and offered little or no pain relief. I am glad to say that she has always received those stories with sympathy, empathy and understanding, but I am receiving more and more of them all the time.

This is not an issue that gets huge acclaim or interest in the press. People are finding our campaign and Facebook page simply because they need to. I will put just two experiences on the record today.

[Jim Shannon (Strangford) (DUP)]

As my party’s health spokesperson, I am interested in all health issues, but particularly in this one, so I commend the hon. Lady for securing the debate. The National Institute for Health and Care Excellence guidelines published in March recommend that women should be offered an out-patient hysteroscopy if they have symptoms or risk factors associated with gynaecological conditions. Does she agree that that recommendation has not been translated into GP referrals? More must be done to ensure that those in need of the procedure, for the purpose of early diagnosis or the removal of issues, are referred and treated in an effective manner. It has to be done early, and that is where we fall down.

[Lyn Brown]

I entirely agree, but the importance of early action is sometimes used to encourage or even force women to stay with a procedure that is causing them great pain because of the fear of what might happen afterwards. If the hon. Gentleman gives me a moment, I will illustrate that point.

In October, I heard from Jenny, who has undergone two hysteroscopies, both of which were traumatic. She told me:

“My first experience was shocking. I wasn’t prepared for it. The doctor didn’t warn me at all, and during the procedure I experienced the most unbearable pain ever and I almost fainted. I rose up from the bed that I was on and I shouted out. It felt like my insides were being ripped out. I wasn’t given the option to stop nor was I given any support.

The nurse was behind the doctor throughout the procedure and just watched as I suffered. After the procedure my legs were like jelly. I felt faint and in pain but I wasn’t even helped off the bed, I wasn’t even given a sanitary towel to help with the bleeding. I left the room and drove myself home in that state, I’m lucky I didn’t have an accident. I felt traumatised, in a state of disbelief and shock.”

What is even more shocking is that Jenny’s second hysteroscopy was also traumatising, even though she now knew the risks and had taken steps to ensure that the same thing would not happen again. She explained to her doctor what had happened and requested a female doctor the next time. Her doctor said that she would write that on the referral, and at her pre-hysteroscopy appointment Jenny was told that she could have an injection to numb the area. She was reassured and trusted the female doctor to be more careful, but the procedure was—again—horribly traumatising. Jenny said:

“My god it was shocking, I once again shouted out and raised from the chair this time. The nurse was trying to calm me down…while the doctor said she would stop at any time but she needed to go in again and take a biopsy. I was told that if she didn’t...the procedure would be incomplete and I would be left worrying that it could be cancerous. So I endured more excruciating pain.

I wasn’t given the option to come back and have the procedure done under general anaesthetic, which I have now found out could have been an option. I felt tricked into having the procedure.

I suffered with terrible pain for a week after. Mentally I was left traumatised and still am to this day.”

Understandably, Jenny is now scared about any gynaecological procedure—including smear tests, which she knows are essential for her health.

This autumn, Annie got in touch. Annie had had ultrasounds and smear tests before; like many others, she was given literature about her hysteroscopy that made her think that it would be no different. She was advised just to take paracetamol and ibuprofen before the appointment, and she felt confident. She told me:

“As the procedure began, I felt instant pain, so unexpected and intense that I began to cry and panic within seconds. I was asking the nurse if this was normal as I was so scared there was something wrong, and she nodded to reassure me. I couldn’t get my words out, I was panicking, going into shock. She offered me her hand to squeeze through the pain. I tried to be strong, but I couldn’t, I was yelling out in pain, shaking and crying.

The nurses were telling me to relax my legs but it was impossible. When the Dr began the biopsy it was by far the worst pain I have ever suffered. I was hyperventilating and the nurse was telling me to breathe, but I couldn’t. I endured pain for 15-20 minutes.

I was asked to wait before I stood up, and I was so traumatised and sobbing, I just couldn’t move.

After a couple of minutes I got up and had to put on a sanitary towel and get dressed. It was hard—I was disoriented and shaking.

I sat with the Doctor who told me that due to it being too painful I have to have polyps removed under general anaesthetic. I could barely talk to him due to shock and tears. I wasn’t even offered water, and nobody asked me how I was getting home.

I cried from leaving the hospital at 2 until my wife arrived home at 6, at which point I broke down uncontrollably in her arms. I felt violated and abused, and the procedure felt very very wrong.”

As we know, women are still having these terrible experiences. I received another story in the past two weeks, but I do not have time to share them all. Women are still leaving NHS care feeling violated, and it ain’t going to stop unless we choose to stop it. I am very grateful to the Campaign Against Painful Hysteroscopy for providing support to those women and making sure that they are heard. The campaign group’s petition has received more than 47,000 signatures, which demonstrates that this is not an unusual, occasional thing.

We have four asks. First, if we are to stop patients from being violated or misled, all NHS trusts need to provide accurate information that enables women to give genuinely informed consent. I was pleased to hear from the Minister that her Department is developing tools to improve hysteroscopy care; I look forward to hearing her elaborate on those tools, but involving patients will be essential to making them work. The campaign wants to see a new patient information leaflet made available across the NHS. Campaigners have been working with the Royal College of Obstetricians and Gynaecologists and with specialists to create an appropriate leaflet that patients who have had negative experiences of hysteroscopy have helped to write, but it still needs to be rolled out.

The leaflet needs to be honest with patients. It needs to warn that there is a real risk of severe pain during out-patient hysteroscopy, and explain the risk factors that make pain more likely. They should tell patients that they have the right to ask for the procedure to be stopped at any time and for it to be rescheduled with a full anaesthetic. Hospitals should no longer have any excuse to hand out literature stating there will only be

“mild discomfort, just like a smear”.

After they have read through the leaflet, patients should be given an opportunity to discuss with a trained doctor what is going to happen during the procedure—whether a sample is going to be cut out for a biopsy, the risks involved, and the anaesthetic choices available. The campaign suggests that both patient and doctor should then sign a consent form to confirm the discussion has taken place and the choices the patient has made.

Our second ask is for improved training to enable better and more consistent care. We know that hysteroscopy can be a painless experience for women—some women will experience little pain from hysteroscopy even with minimal anaesthetic—but as we have heard, for others it will be like torture. There are some risk factors—older women and women who have never had children are far more likely to experience severe pain during hysteroscopy—but we cannot tell in advance what someone will experience, and that means we have to improve the guidelines and raise standards through training. The current national guidelines, produced by RCOG and the British Society for Gynaecological Endoscopy, do not recommend several forms of anaesthetic that I am told could be helpful. That has to be looked at, because, for some patients, stronger forms of anaesthetic might be the only way to have a hysteroscopy without experiencing severe pain.

Once we have changed the guidelines, investment in training will be needed to embed new best practice across the NHS. Hysteroscopy nurses should be routinely asking for patients’ pain scores during the procedure, so that informed decisions can be made about whether to continue or to stop. We need to audit pain scores and keep records of how comfortable the surgeon was with continuing, so that we can monitor whether more training is necessary. It should be a basic element of training that hysteroscopy teams should simply stop the procedure if a patient is suffering severe pain—not just hold them down—and reassure the patient that the procedure will be promptly rescheduled with more effective anaesthesia, rather than using the threat of possible undetected cancer to encourage her to continue.

Our third ask is for enough resources to enable all NHS bodies, everywhere in the country, to give women the choice between different anaesthetics when they need a hysteroscopy. The problem is not just flawed guidelines and inadequate training. Trusts may be loth to enable anaesthesia beyond over-the-counter painkillers or local anaesthetic simply because other methods are more expensive. Some are in-patient procedures, and some require clinicians to have specific training, and we all know that that comes with extra costs.

Our fourth, and possibly most important, ask is for a change to NHS incentives for hospitals. According to the information we have, the Department of Health’s quality, innovation, productivity and prevention tariff encourages trusts to promote hysteroscopy without anaesthetic, rather than offering an open choice to women. Annex F to the 2017 to 2019 national tariff payment system is explicit:

“For...diagnostic hysteroscopy...the aim is to shift activity into the outpatient setting.”

The best practice tariff

“is made up of a pair of prices...one applied to outpatient settings, the other to...elective admissions. By paying a higher price for procedures in the outpatient setting, the BPT creates a financial incentive for providers to treat patients there.”

The national target is for the risky out-patient hysteroscopies to increase to 70% of the total, up from 59%. The Department for Health is not working to reduce pain and trauma for women—it is incentivising hysteroscopies without effective pain relief and is taking our choices away. It has to stop, and I hope the Minister will look at how she is going to stop it.

Those are our four asks of the Government, and I think the Minister will agree with me that they are entirely reasonable. I do not believe they would be massively expensive to implement, and we should also consider that current NHS practices may not be cost-effective. Women who have undergone a painful hysteroscopy may not return for other gynaecological tests and procedures. If they do not have those early preventive interventions, more costly interventions will be needed later.

Some action has already been taken. The issue has been raised with the national medical director of NHS England. I thank the Minister for that, and for launching her women’s health taskforce, which I would be interested to hear more about today.

I would like to say something about the history of the hysteroscopy campaign and the amazing women who have led it—I am delighted to see some of them in the Gallery today. With their support, I have regularly been raising this issue in the House for four years now. I cannot say progress has been easy or swift. At times I—we—have been ignored by the Government, despite strong cross-party support every time I have raised the issue. I have been left concerned that officials at the Department of Health, and some senior NHS managers, have not been willing to engage with the problem of women’s pain when the NHS is under financial stress.

However, this last year has been more hopeful. The Minister met me and a core group of campaigners last year, and listened with compassion to their stories. I believe she has taken this cause as her own. I am waiting with bated breath to hear what she is going to say today, and to hear about the rapid and dramatic progress we are going to be able to make on this issue over the coming year.

Psychoactive Substances Bill [Lords]

Debate between Jim Shannon and Lyn Brown

Wednesday 20th January 2016 Commons Chamber

[Lyn Brown]

I am going to come to that later in my speech when I talk about Wales. Although there has not yet been a proper examination of the findings from the drugs programme that Wales has put into action, the initial findings appear to show that it has had some impact. If my hon. Friend will allow, I will continue with my—[Interruption.] Thank you: I will continue with my oration.

The evidence, including from the Government’s own inspectors, suggests that the Government’s approach to PSHE simply is not working. This failure has occurred at a time when the growth of the new psychoactive substances industry has started radically to alter the drugs situation in our country.

Moreover, parents want these changes. A National Union of Teachers survey suggests that around 88% of parents want PSHE to be compulsory. A 2011 survey conducted by Mumsnet showed that 98% of parents were happy for their children to attend PSHE lessons.

[Jim Shannon (Strangford) (DUP)]

While this legislation will go some towards addressing legal highs, there is still the issue of the purchase of legal highs online. Does the hon. Lady agree there is still much to do in relation to that?

[Lyn Brown]

I agree that there is much we can do to prevent the supply of, and demand for, these substances. This set of amendments is dealing with demand, and I feel that, unless we get across the message that these so-called legal highs are neither legal nor safe, the demand on the internet will become even greater. We need to get across the core message that the Government are sending through this Bill: these drugs are not legal and not safe. The demand on the internet needs to be curbed as well, which is why we need to make sure that we have proper education and information out there.

Teachers, parents and the Government’s own inspectors think we should have more and better drugs education, but it appears that the Government do not agree. In Wales, a Labour Government show us how successful an alternative approach can be. A £2 million investment in the all-Wales school liaison programme has made substance misuse education a core subject in 98% of Welsh primary and secondary schools. Almost all Welsh schoolchildren receive accurate, consistent and credible information about the potential harms of drugs, rather than having to rely on friends, myths, the internet and guesswork. The school programme is complemented by the Welsh emerging drugs and novel substance project, a new psychoactive substances information and harm reduction programme, as well as measures to educate parents. These are all part of a £50 million investment in reducing drugs harms.

There are signs that the Welsh approach is working. Drug deaths in Wales are down by 30% since 2010. By contrast, drug-related deaths have been creeping up in England. There was a 17% increase in the last year, and the Office for National Statistics states that they are now at the highest level since records began in 1993.

Too much of the drugs education in our schools is focused on providing information. Evidence suggests that to get drugs education right, it has to be taught alongside a focus on the life skills which empower young people to resist peer pressure and make informed decisions.