Cosmetic Surgery

Joe Benton Excerpts

Thursday 5th July 2012 Westminster Hall

[Mr MacShane]

He is very generous. Can I inform the Minister and the House that today is the 64th birthday of the NHS? Why not give a birthday present to those lovely ladies and say that the NHS will look after them before its 65th birthday? Come on, Minister, take a decision. They will not kill you on the box. We will talk to the Secretary of State for Health and sort it out.

[Mr Joe Benton (in the Chair)]

Order. Before the Minister replies to that intervention, I point out that there is another debate to follow this one. Try to keep interventions to a minimum. The debate has gone well past 4 o’clock.

[Anne Milton]

We have tried Mr Benton’s patience. I thank the right hon. Member for Rotherham for his suggestion. I am sure that the Secretary of State will listen closely to what I say next. Changing Government policy on the hoof during a debate—

[Anne Milton]

It might indeed. It might also be a career-limiting move.

The surgery must be based on clinical need. I cannot see any way out of the dilemma. It is difficult, and as I said, the strength of feeling in this debate will have been noted.

Moving on, I know that the Health Committee has criticised the MHRA for not finding a way to communicate to women with PIP implants, preferring instead to use its central alerting system, the national media and specialist associations as its main channels of communication. We should recognise that that approach clearly did not work well, although it was possibly understandable at the time. Since then, active social networking sites have developed. It is right that both the Department of Health and the MHRA need to find better ways of communicating.

I finish by talking about some of the wider issues that have been raised, specifically Sir Bruce Keogh’s ongoing review. It is a wide-ranging review of all aspects of the regulation of cosmetic interventions: the devices and substances used, the practitioners involved and the way the organisations work. It will pay particular attention to the marketing and promotion of cosmetic interventions, and the need for fully informed consent. The review is expected to report by March 2013.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) raised the issue of informed consent. Nothing could be closer to my heart. I have heard some dreadful stories from women who went in for breast augmentation and, literally two or three minutes before they were about to go under anaesthetic, somebody rushed in with a form saying, “We’ll lift your eyelids or give you a facelift at half the price if you sign here now.” Absolutely outrageous. A lot of women, even if they were informed, did not feel informed, and that is what matters. It is not good enough just to tell people. It is important that the surgeon, and all those undertaking the procedure, are satisfied that the woman, or indeed anybody else having any sort of surgery, is fully informed.

There is information about lists of medical devices. It is worth putting on the record that the EU is currently revising the regulations on them, and looking at medical devices.

On the number of substances that were found in PIP implants, we have to be very careful and stick to science. All sorts of chemicals are found in hip replacements, knee replacements and all the other things that can be implanted for medical reasons. The important point is whether they have any impact on health.

Insurance was mentioned. It will be looked at. Professional standards are two words that are rarely heard. In reviews after bad things happen, we rarely talk about professional standards. It is extremely important that we do talk about them.

Issues were raised about loss of licences and the need to keep records so that we can make timely, prompt contact with people who are affected when things go wrong, as they inevitably will from time to time. It is important that we do everything beforehand to ensure that they do not go wrong, but that if they do we have access to the women. That is why we need Sir Bruce Keogh to look at that work, and clinical licensing systems and compulsory insurance too. I am very grateful to the Committee for its many helpful suggestions, all of which will be taken forward by Sir Bruce’s team.

I end with a note about some of the women who have taken the time to talk to me. It is very hard to understand the distress caused when terrible things happen, particularly when people have previously trusted the organisation, and maybe the surgeon, that they were dealing with. Betrayal of trust is a dreadful thing. It can be awful if they go back and there is nobody to help them. In some instances, women have gone to their GPs, and even their own GPs have cast inappropriate value judgments on them and not been as helpful as they should. For many women, we cannot turn the clock back, but we can make sure that this does not happen again.

[Mr Joe Benton (in the Chair)]

There are two minutes for a winding-up speech, if the right hon. Member for Charnwood (Mr Dorrell)wants to speak.

Child and Adolescent Mental Health Services

Joe Benton Excerpts

Wednesday 7th July 2010 Westminster Hall

[Several hon. Members]

rose—

[Mr Joe Benton (in the Chair)]

Order. The debate lasts only one and a half hours. Several hon. Members have indicated that they would like to speak—I will do my best to call them all—so perhaps they will bear that time limit in mind, and that I propose to start the winding-up speeches at 3.40 pm.

--- Later in debate ---

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate. Hon. Members who know that I come from north of the border may wonder why I choose to speak on a matter that essentially relates to devolved issues in Scotland. However, in a number of areas, we have to look across the UK, and the National Autistic Society has a facility—Daldorch House—in my constituency, which has become a centre of excellence in the local area and is looked to by a number of local authorities, not just in Scotland but across the UK, for advice on how to approach work with young people with disorders on the autistic spectrum.

I have taken an interest in this subject over many years, and I first came across young people with disorders on the autistic spectrum 30 years ago as a young art therapist. It is fair to say that there have been a number of positive moves both in recognising the range of issues that people face, and in looking at different ways of working with people and the different services required. Despite all those improvements, all of us as elected Members of Parliament will come across people in our constituencies who still have to battle, fight and almost scream from the rooftops to get the services that they need for their children.

One difficulty that people often face—I certainly experienced this as the Minister responsible for education in Scotland when I tried to introduce legislation that should have provided additional support for learning—arises because parents are suspicious of any change, as they feel that it might lessen the rights of young people, rather than give them increased rights to education and other support.

This morning, I received in my e-mail inbox a piece of correspondence from a constituent, which I think sums up how much further we still have to go. The parents were writing about the needs of their teenage son, and the difficulties that they have encountered in finding appropriate educational placements. Their son is already in a school but, according to the parents, that school does not have the necessary skills and experience to cope with him and does not want him there for reasons of health and safety. Another school has been identified in the local authority area, and although it has the skills and expertise, it does not have enough support staff to take the teenager on. The parents are extremely worried about the impact of budget cuts that are already being made in the local authority, with learning support assistants—and others—being made redundant.

As a result, those parents told me that they do not know whether any schooling will be available for their son after the summer break. They have been advised by both schools that they are unlikely to hear anything from the education authority until two days before the start of the new school term. All hon. Members who are aware of the issues surrounding education for young people with disorders on the autistic spectrum will know that that is an unacceptable way to deal with young people who require support and preparation, and for their parents, who need to know what is going to happen.

I am conscious of the time, but I want to say that we must work to identify who these young people are. Every local authority and health board has a responsibility to identify young people with disorders on the autistic spectrum and put in place appropriate support packages. I am concerned that we are not doing enough to recognise that those young people will grow into adults, and at some stage will require not only support to enter further education or employment and all that goes with that, but support with the ageing process. At some stage, there will be a significant number of people approaching their elderly years who are diagnosed as having a disorder on the autistic spectrum. We have not done anything to look at that issue.

It is important that parents receive support. Everyone who has been the parent of a teenager knows that it is a difficult time. I used to joke that my son disappeared into his bedroom aged 14, and came out a better person aged 17. [Hon. Members: “Too early!”] Perhaps I was lucky. For people who have teenagers with disorders on the autistic spectrum, it is a difficult enough period. The added pressures and the support that parents require have not been adequately recognised.

We must pay attention to the number of people who end up in young offenders institutions and prison systems but who probably, had their condition been picked up at an earlier stage, would have been diagnosed as being somewhere on the autistic spectrum. I have also raised that issue in a Scottish context. When people are in a place such as a young offenders institution or prison, we should be able to identify the problem, get them the appropriate help and support, and look specifically at how we can help them in the future.

I am grateful for the opportunity to make a brief contribution to the debate. When the Minister responds, perhaps she will say something about what the Government are planning to do about the transition from education into employment, and about the specific issue of how we can provide support for people as they go through the ageing process and inevitably require a degree of support from the state.

[Mr Joe Benton (in the Chair)]

I call Roger Buckland.

--- Later in debate ---

[Anne Milton]

I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.

I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.

We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—

[Mr Joe Benton (in the Chair)]

Order. We must move on to the next debate.

Supporting Carers

Joe Benton Excerpts

Thursday 1st July 2010 Westminster Hall

[Mr Joe Benton (in the Chair)]

Order. Before I call the next speaker, I refer again to the fact that 10 Members have so far indicated that they want to speak. As Members know, the debate will finish promptly at 5.30 pm. Obviously, I will do my best to accommodate everybody, but that is not a matter for me. However, I ask hon. Members to bear that in mind so that everyone can speak.

--- Later in debate ---

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Benton, although the matters that I have to deal with are somewhat distressing. I wish to address the proposed closure of the Hammersmith and Fulham carers centre, which is the main carers centre in my constituency. Hammersmith and Fulham council is closing the centre at the end of July in the most irregular and arbitrary way, and that will leave no service for carers in the borough for the foreseeable future.

I should perhaps begin by declaring an interest. The centre was set up in 1998, when I was the leader of the council, and I have been a strong supporter of it over the past 12 years. The centre occupies substantial premises in Hammersmith road, which is about five minutes’ walk from Hammersmith Broadway, so it is located in the centre of the borough and highly accessible for the carers who use it. It has a lot of space, so it can run activities, and it has—or had—six staff. It has provided a service to many thousands of people, and I shall read some of their testimonials in a moment, but let us just say for present purposes that it has run a good service. It should now be delivering a service to adults and young people using its budget of £300,000, which is split roughly 70:30 between those two groups. In addition to providing services in the main building, it also provides outreach services across the borough.

In 2008, the then relatively new Conservative council decided to conduct a tendering exercise. It is a moot point as to whether that was necessary, and the council failed to identify whether the body involved should be voluntary or whether staff would be employed by the council, but it went ahead. The problem was not the exercise itself, but the fact that it was so incompetently managed that three separate tendering exercises were carried out over the ensuing two years with no successful resolution. Despite the council going to great lengths and spending a lot of money on the process, the most recent exercise had only one bidder, which was the existing carers centre. The centre passed its appraisal, at least as far as the adult part—the majority part—of the quality assessment was concerned, so it anticipated being awarded the contract. However, at that point—again, entirely arbitrarily—the council decided that it would terminate the contract with immediate effect. Indeed, it should have been terminated yesterday, on 30 June, but a winding-up extension has now been granted until the end of July.

Some people thought that these events might be connected with the fact that the council, as part of its fire sale of most of the borough’s capital assets, wanted to sell off the building for an estimated £1.7 million. It had initially tried to move the centre into small, unsuitable premises in a less accessible location, which had to be accessed through another charity’s premises, but it then decided to get rid of the centre altogether.

Events then take a more remarkable turn. The chair of the management committee, Kamaljit Kaur, who has an extensive background in the voluntary sector, has been trying to run the centre in an exemplary way over the past few years since taking over that role. She met the council’s director of adult services on 23 June and failed to persuade him—because his mind had already been made up by politicians—to reconsider or even to extend the centre’s tenure while alternative provision was made. We now know that there will be no alternative provision until at least April. After the failure of that meeting, she wrote a letter to carers and other interested parties, including me, in very mild terms given the circumstances. Part of her letter read as follows:

“The Council went through a tendering process for Carers Support Services and made three attempts to attract potential bidders for this contract. However, we were the only bidders for their adult and young carer’s contracts. Our bid was evaluated by the Council's TAP: our bid was successful in the adult carer’s contract and was recommended for funding by the TAP, but eventually turned down at senior officer level.

The Council have been informed that the prime reason for the lack of interest in this contract for potential bidders was the requirement to employ existing centre staff and the financial liabilities that go with this requirement. We now believe that the Council's sole intention behind closing down the Carers Centre is part of its strategy to remove existing staff, thereby removing the requirement for new bidders to take on this financial responsibility. We also believe that this will attract national organisations to bid for this contract.”

That is quite likely, because that is a method that the council has used before—getting rid of local organisations and bringing in national ones that they believe can handle matters cheaply if not as well.

The response to that letter, which also explained how people could protest about what was happening, was an extraordinary six-page letter from the director of adult services making serious personal allegations against the chair, including an allegation of an improper family relationship with someone who had a pecuniary interest in the contract. Late last night, the councillor responsible—Councillor Carlebach—and the director of community services had to issue an apology:

“Since issuing our letter of 28th June on this matter, we have received a single representation that we have misunderstood and mis-stated the position”.

They state that they are

“writing to clarify that it has now been made clear”

to them that the individual in question

“is not the brother of Kamaljit Kaur.”

The letter continues in an exculpatory way to try to excuse them for what happened. The chair informed me earlier that she now feels under an obligation to resign and is taking legal advice with a view to an action for defamation. I do not want to pursue that matter, but I simply set out those facts to show that the local authority is out of control and behaving in a highly improper way—as it is in many other respects.

Leaving aside the process, what is the effect on carers? Hon. Members might have seen in the debate pack an article from The Guardian of 16 June, part of which I shall quote:

“For 12 years, Margaret Turley has known where to go in a crisis. Eighteen months ago, when the 26-year-old learning-disabled son she cares for developed epilepsy and began going blind, Turley headed for the Princess Royal Trust Hammersmith and Fulham Carers Centre.

‘You’re among people who know what carers do,’ she says of the Hammersmith Road centre in west London. ‘I can come in here just because I’ve had a horrendous day.’ The centre provides advice and peer support, and runs a Department of Health-funded programme, Caring with Confidence, offering free training for carers who want to develop their caring skills.”

Later the article says:

“Pat Williams, who cares for her disabled son and runs the Caring with Confidence sessions, says: ‘It’s a fait accompli—get us out of the building, don’t give us the contract, and run the organisation down.’ ”

Hon. Members will not be surprised to learn that I have received an extraordinary number of letters about this matter. I will not take up too much time, but I want to read excerpts from some of them, as I think that hon. Members should realise what a serious matter this is for thousands of carers in my constituency. I shall not give names, but one letter states:

“I have been a member of Hammersmith and Fulham Carers Centre for the last 10 years and have relied on the Centre for support through all my times of crisis during those years…I am shocked and devastated at the closure of the Carers Centre…Not only will the Centre close, but there will be no co-ordinated service for carers…How can the Council close down our service and offer nothing in its place? What on earth are the Council playing at?”

The letter continues:

“I can get no sense from anybody at the Hammersmith and Fulham Council…In the meantime, where will we H and F Carers meet for our support groups? Who will we talk to when we need help? Will a building be made available to us? Without a place to come to, when we are in distress, how will we manage?”

Another carer wrote:

“Dear Andy, I am one of the borough’s many fulltime carers and have learned this week that after some 12 months of what the council has termed ‘review’, they have pulled all funding from the carers centre…My 2 sons use the services of the Young Carers Group, and get the kind of support and respite that we will not, again, find anywhere else. I feel passionately that carers are such a soft target, as our responsibilities make it so hard to mount the kind of defence of these services that they deserve.”

Another of my constituents writes:

“I care for my mother who is over 90 years, and also my daughter who is disabled. I do use the carers centre and found that the people who run it are very helpful.”

A further letter reads:

“I have been caring for my wife with severe dementia for 20 years, and the aspect that worries me most is the fact that the centre holds the emergency contact to look after my wife, if anything happened to me; an accident or such like.”

This is the letter that touched me most:

“I am an eleven year old boy. I have a brother with cerebral palsy. My dad died when I was seven from a heart attack. I love my brother so much but I had to face very difficult things. Children have made fun of me because of my brother’s condition. People that don’t understand my brother’s condition treat me differently to other people. I didn’t go on holidays. People made fun of me when I was near my brother. I missed a lot of school. I felt stressed and unsure. I was unsure if I was doing the right or wrong thing. I didn’t have anyone to talk to.

When I first went to the young carers project I made friends quite quickly. I told them my experiences and they told me theirs. The young carers project took me on trips and I was able to express my emotions and feelings. They helped me to understand bullies and that there was nothing wrong with me. They helped me realise that I did do things correctly. They also took me camping, which was lots of fun and taught me different dances for example street dancing and martial arts style dancing. It is a chill out zone for all young carers and adult carers. It gives us freedom from our caring role.

If you close the young carers project, you'll be closing a family of people who came together because of difficulties. Which is unfair for all young carers and adult carers. I just can’t believe you’re closing down the young carers project for all the good work they have done.”

There is, of course, substantial resistance to the decision. There are daily pickets outside the town hall. I have written to the leader of the council to ask him, at the very least, to extend the contract until alternative provision is in place, and to allow the carers centre to bid again for the contract. The matter was debated at full council last night on a motion from the Labour opposition, but of course that was voted down by the Conservative majority on the council. Given the exceptional circumstances that I have set out, I ask the Minister to take a personal interest and to look at the matter. I believe that the situation has arisen not simply because the council is a Conservative one; the local authority is acting without its jurisdiction, in a highly improper way.

What I have described is not an isolated incident. Some hon. Members might know about the council newspaper in Hammersmith and Fulham. Last weekend, the Secretary of State for Communities and Local Government, referring in part to the Hammersmith and Fulham council newspaper, said:

“Councils should spend less time and money on weekly town hall Pravdas…our free press should not face state competition from propaganda on the rates dressed up as local reporting.”

To read the paper in question one would think that everything was well at the carers centre. According to its front page, the leader of the council says:

“We will sell assets we no longer need because, when times are tough, we have to put services before buildings.”

Last night, the council announced a fire sale of most of the public buildings in the borough, ranging from the Irish centre in Hammersmith Broadway, which has an international reputation, to Fulham town hall and many voluntary sector buildings, including one that was referred to in the article in The Guardian, Palingswick House, which is home to more than 20 voluntary groups but is to be sold later this year.

Lest there be any doubt, the incident that I am recounting is not a mistake or isolated incident; it is a calculated attack on the poorest and most vulnerable people in the borough of Hammersmith and Fulham, in the guise of putting through a policy that was never agreed. It is being put through not just callously, but without the remit of the local authority. I ask the Minister to take a particular interest in what is happening in Hammersmith and Fulham not just because of the staff and the build-up of expertise in the past 12 years, which will be lost for ever at the end of next month if a stop is not put to what is happening, but on behalf of the thousands of people—we believe that there are more than 11,500 adult carers and many young carers in the borough—who rely on an excellent service, but will be without it from next month.

[Mr Joe Benton (in the Chair)]

Before I call the next speaker, I ask all hon. Members to ensure that they have switched off their mobile phones.

Human Tissue (Availability)

Joe Benton Excerpts

Wednesday 23rd June 2010 Westminster Hall

[Mark Tami]

My hon. Friend is exactly right. Men are certainly less willing to become stem cell donors and bone marrow donors, because we are cowardly and do not like needles. That is a particular problem.

What we must do with bone marrow and stem cell research, as the work of the Anthony Nolan Trust shows, is to put fewer obstacles in the way of donors. When it comes to giving blood, I know from my own point of view that my reaction is really, “Argh”—giving blood really terrifies people. However, mouth swabs can be used to donate other material. If we can get people past that first stage and if they are then approached because they are a potential match, I think that people will say, “I am a potential match and therefore I will go to that next stage and give blood”. If we somehow phase people by saying, “You’ve got to give blood and you must have various tests for things”, then people are less likely to come forward.

Obviously, with bone marrow and stem cell donation, we are not talking about people who have died. It is one of the few areas where someone can save a life by giving something. It is not painful, it does not take that long and someone can actually save somebody else’s life. There are tens of thousands of people out there who do not even know that they are potential life-savers. This issue is not only about how we raise awareness, but how we—

[Mr Joe Benton (in the Chair)]

Order. The intervention is too lengthy.

[Mary Creagh]

Thank you, Mr Benton. I was listening with interest and totally agreeing with my hon. Friend. Most of us will not have the chance to save someone’s life in the normal way. The chance to be an everyday hero does not come to many of us, and most of us do not have the medical skills that would enable us to be one. However, a person can undergo a small surgical procedure to take bone marrow out of their hip, and someone else will be walking around as a result of their generosity to another human being. I find that profoundly moving.

We need to look at where the responsibility lies for raising awareness. We as politicians are in this room debating the matter, so we are fulfilling our responsibility.

We have heard of the difficulties that the media create in their coverage of these issues, some of which have been difficult. The Alder Hey and Bristol Royal Children’s hospital cases were seen as national scandals, and rightly so, but the scientific community has a huge responsibility in this area. This country has a problem with science. We have a framework that enables us to be world leaders in life sciences and all kinds of areas, and we have a population that is willing to run marathons, to do fun runs for breast cancer and cancer research and to work and raise money. Yet there is a gap.

Presumably, every one of the women who participated in the five-mile fun run in Wakefield—the race for life—did so because they knew someone who had died of or suffered from breast cancer. All those women could have been offered the chance to be screened for blood marrow donation or to talk about tissue sampling. The world of fundraising needs to work more closely with the world of research. I do not know how that would happen, but I think that the scientific community, whether it is researching genetically modified foods, cancer or Parkinson’s, has its own responsibility. However, it has not found its voice in this area.

We have an image of scientists working in their labs in white coats. It has been a long time since I have been in a research lab, so I do not know whether they still wear those coats, but they do not get on the telly. We tend to hear about sensational breakthroughs, but when we read the small print, we find that they are at least five, six or 10 years away. There is media sensationalism about what might be small steps at the beginning, yet no real conversation about the long, arduous and painful work that scientists have to go through to achieve a breakthrough. I agree with the hon. Member for East Dunbartonshire that there is not enough access to tissue samples, but there are difficulties at the interface between the two worlds.

My hon. Friend the Member for Alyn and Deeside mentioned cord blood collection. The Royal College of Midwives has specifically said to its members, “We do not want you to be distracted by cord blood collection while you are trying to deliver a baby.” Obviously, anyone who is assisting at a birth wants a happy baby and a happy mum. The cord blood thing comes much farther down the line. Certainly, that was my experience of giving birth, and I believe that it is probably the experience of most medical professionals.

The scientist is not in the room saying, “By the way, make sure you get the cord blood, and make sure you put it in the fridge quickly.” If a midwife is dealing with a baby that might be in respiratory distress or a mother who is in the middle of a haemorrhage, all other considerations rightly go out of the window. The midwife wants a safe delivery, and the researcher stands in the university lab and weeps as the precious cord blood heads off with the placenta to the incinerator. I do not know whether people still take the placenta home. I certainly was not interested in that; we are back to the “ick” factor.

There is a challenging conflict between the NHS professional who wants to deal sensitively with, for example, a cancer or Parkinson’s patient, and the colleague back at the lab who wants to know whether they have consent to do lab work on the tissue samples. We have heard some interesting suggestions today about how the medical process can support the collection of tissue. Most hospitals have introduced MRSA screening prior to surgical interventions, and that would be a good way of doing it.

The national patient care record—a national database with everyone’s details—is another possibility. The patient could sit with their general practitioner and go through organ and tissue donation. The information could be there in black and white on the computer screen for every medical professional who deals with them at any stage of their life. The decision could also be revoked at any stage.