Huntington’s Disease

Laurence Robertson Excerpts

Wednesday 9th November 2022 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

We come to the Front Benchers’ speeches. I call Stephen Bonnar.

Menopause

Laurence Robertson Excerpts

Thursday 9th June 2022 Westminster Hall

[Charlotte Nichols (Warrington North) (Lab)]

It is a pleasure to see you serve in the Chair, Mr Robertson. I commend my hon. Friend the Member for Swansea East (Carolyn Harris) for securing the debate, and for her ongoing commitment to pursuing wider public understanding and support for menopausal and perimenopausal women. The fact that all four nations of the UK are represented here is a real testament to the diligence, determination and doggedness of her campaigning. Having spoken in the debate that she secured last year, I am pleased that this is now a regular feature, and that the needs and experiences of women undergoing this stage of life are now being properly considered.

According to Hansard, the first time that the word “menopause” was used in our Parliament was in 1943, in the Lords, in a debate on “population problems”. It was not mentioned in the Commons until 1964, and the 100th reference was not until 2017. We are in a much healthier position now that we can consider it as one of the areas of life that we should properly appreciate.

I was struck by the comments from my hon. Friend the Member for Swansea about the experiences of women wrongly prescribed antidepressants and anxiety medication when what they needed was HRT. I know at first hand the life-saving potential of medications of that type, but only when they are appropriately prescribed. Side effects can often include excessive sweating, insomnia, agitation, anxiousness and dizziness—all things that can, themselves, be symptoms of menopause. That means that the wrongful prescription of those medications could actually exacerbate the very misery that caused affected women to seek medical support in the first place. At best, it would be treating some of the symptoms but not the underlying causes.

Let us hope that, as a Parliament, we are reflecting a society that increasingly understands and accommodates the symptoms of menopause, which affect so many in our country—around 5.1 million women aged between 45 and 55. As the right hon. Member for Romsey and Southampton North (Caroline Nokes) made clear, many younger women, and people who do not define themselves as women at all, also experience this. They may find it even more difficult to access support as they do not fit the typical profile.

It is essential that every affected person feels confident and able to discuss their symptoms with their employers, and to have requests for workplace adjustments met. We have all now had the chance to see the value of flexible working, and if a woman suffering from hot flushes asks to wear a more forgiving uniform, or to change her work hours so that she is not commuting in crammed transport during rush hour, that should be granted. That is an area that should have been included in the long-promised employment Bill that was so glaringly absent from the Queen’s Speech.

Throughout my career I have often been lucky enough to be one of the youngest, if not the youngest, women within my team, and to have been surrounded by women who were older and more experienced, and who were often going through symptoms of the menopause or the perimenopause. It has meant that I have had the benefit of watching them, listening to them and hearing them. Their generosity, in talking about what they were going through, means that when I get to that stage of life I will know what to look out for, what treatments are available, and what adjustments I should be able to ask for, demand and expect from my employer. We need to foster cultures in every workplace that allow people to have those conversations with each other, with younger colleagues and with their employer, and importantly, to be listened to so that accommodations can be made. That will set a really positive precedent for our society as we move forward.

An important part of that wider societal understanding is the inclusion of menopause in relationship and sex education classes in schools. I am glad that that has been the case since 2019, but I would like to hear from the Minister about how widespread that teaching is. It would be ironic if our children now learn more about menopause than our medical professionals do. Last year I challenged the then Minister, the right hon. Member for Mid Bedfordshire (Ms Dorries), about gaps in training at medical schools, as 41% do not teach about the menopause. She promised improvements by 2024, but I would like to know what the figures are now, because we cannot improve what we are not consistently measuring and tracking.

Many of the physical challenges of the menopause can be addressed through HRT, but access should not be a postcode lottery dependent on GP understanding or sympathy. In Wales and Scotland, women benefit from free prescriptions, including for HRT treatments. Can the Minister tell us what more the Government will do to ensure affordable access, particularly in the context of our current cost of living crisis, and what steps are being taken to address the issues of supply that have been raised by right hon. and hon. Members across the House?

To conclude, I am delighted that this is becoming a regular discussion, not least because we can therefore hold Ministers accountable on progress. I hope our questions are answered today. If not, we will continue to raise them at every opportunity, because suffering is not a necessary or inevitable part of ageing.

[Mr Laurence Robertson (in the Chair)]

We now come to the Front-Bench speeches.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Swansea East (Carolyn Harris) on once again securing a debate on this important issue. It is good to see all four nations represented here this afternoon and both men and women involved in the debate. It is my wedding anniversary today, and it is a pleasure to share it with the hon. Member for Strangford (Jim Shannon) and to show our continuing working relationship—[Laughter.]

To reassure hon. Members, progress has been made since the debate held by the hon. Member for Swansea East last October. It was one of the first debates I took part in as a new Minister, and I can honestly say that virtually every day since then we have worked on many of the issues addressed in that debate to improve outcomes for women going through the menopause. This is an important issue for me not only because it is a key priority area in my portfolio, but because I went through an early menopause over 10 years ago. The hon. Member for Edmonton (Kate Osamor) described her struggle to get her GP to take her seriously, but for someone in their 30s it is even more difficult, and it can be a lonely experience if your peers are not going through the same thing. They are busy getting married and having children; they are certainly not talking about hot flushes and not being able to sleep. It can be a very difficult experience. So, for me, this is a personal mission as well as a ministerial one.

I want to reassure colleagues that I absolutely have a laser focus on delivering many of the pledges made in the previous debate. On the cost of HRT, we announced in that debate that we would accept the move towards reducing the costs. It only affects women in England, but it is an important issue. Around 89% of all prescriptions issued in England are free. People qualify for free prescriptions when they are on income support, universal credit, jobseeker’s allowance and pension credit, so the vast majority of people getting general prescriptions are entitled to free prescriptions.

However, women going through the menopause often do not meet those criteria. I fully recognise that the cost is very high, particularly for women who are on two hormones or who have multiple products that they need dispensing. That is why we are committed to introducing the bespoke prepayment certificate for HRT by April next year. It is very different from the prepayment certificates that exist for general medicine. However, there are steps that we have to take. We are expected to consult the professional bodies involved. There will be changes to both dispensing and prescribing. A statutory instrument needs to be laid to make those changes happen. IT changes are also needed to make these things happen in practical terms, so that when women turn up at the chemist, their prescriptions are actually there for them to collect. We are not making excuses, and this will happen by April next year, not from April next year. If we can do it any quicker, we will. The prescription will be £18.70 for all HRT products, whether that is for two hormones or multiple products, and that will be a considerable cost saving for women.

The supply of HRT has been a challenge. We have seen more than a 30% increase in demand, thanks to all the campaigners raising the profile of the menopause but also highlighting the benefits of HRT and breaking the taboos. GPs and doctors were often worried about the safety of HRT, but campaigners have explained that some of the research that was around 10 or 15 years ago is out of date and that HRT is a safe and effective product for many women. So there has been a huge increase in demand. We have met trade suppliers, manufacturers and pharmacists to discuss the challenges they face and to try to overcome them. Of the more than 70 products that are available, we are now down to pressures on three or four, and even with those we are seeing significant progress.

The hon. Member for Belfast South (Claire Hanna) asked for an update. Maddy McTernan, the head of HRT supply, updated the taskforce this week. We are making good progress. There is commercially sensitive information, which we cannot share, but manufacturers are stepping up to the plate to produce extra supplies. It is not about meeting the demand now. Demand will continue to grow, and we need to future-proof to ensure that we are not in the same situation in six months.

The prepayment certificate will also help. Women will no longer have to try to get a prescription for three or four months in order to keep the cost down. They will be able to get a monthly supply and not have to pay an increased cost for doing so. That will help manage supplies overall. We have also introduced three serious shortage protocols for the three products, so that we can manage the amount that is being dispensed and have better stock control. It will also give powers to pharmacists to give alternative products. That is not always ideal, because I know that some women notice instantly a difference in the effect of a drug, even if it is the same drug but with a change in manufacturer. It is not ideal, but it is helping us get through this acute period, and it will enable us to better control stocks in the longer term. We will be updating colleagues as we go through this, and Maddy and the team from BEIS have been helping us hugely with that.

The UK menopause taskforce that has been set up was one of the asks from the hon. Member for Enfield North (Feryal Clark); it was not a Government suggestion. We agreed to it and have had our second meeting. There are four key areas where we want to make recommendations. Those include education—for women, men, boys and girls, and healthcare professionals too. The taskforce will also look at the workplace, health provision, and research into areas such as testosterone, where we need to be breaking some barriers.

In the short time I have, I would like to touch on the workplace issue, which is crucial. One of the key things about the taskforce is that it is not just about health. We have a BEIS Minister and an employment Minister, and we are going to invite, as was suggested earlier, a Minister from Justice as well so that we reach out to all women affected by the menopause. I am really pleased that the civil service led the way this week when we signed Wellbeing of Women’s menopause workplace pledge. That will not just help women in the civil service who are going through the menopause it is to show other employers the sorts of small changes, such as the pink fan mentioned by the hon. Member for Strangford (Jim Shannon), that can make a big difference. It will also enable women and employers to feel confident to have those discussions at work. As my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) said, these women are in the prime of life. We have women with extraordinary experience and talent who we should be harnessing, not letting go.

We are really serious about improving GP training. It has been difficult for GPs to get that specialist advice and support, as this is a growing area, but the General Medical Council will be including the menopause as part of its licensing assessment, so it will be a core part of training. The NHS England menopause programme will be producing resources for all types of healthcare professionals so that we can make sure that people are trained.

I know I have to let the hon. Member for Swansea East come back in—

[Mr Laurence Robertson (in the Chair)]

There is plenty of time.

[Maria Caulfield]

Okay. The NHS itself is setting up a training programme to make sure that at every point that a woman approaches the health service—when meeting GPs or nurses—they get the specialist training they need.

The women’s health strategy is coming forward. I would rather spend time getting it right than rush it through to meet a deadline. We are weeks away from publishing. We have already published our vision and the findings from the consultation, and the strategy will build on that. The menopause will be a priority area within that document. We will also be announcing a women’s health ambassador very shortly, who will be holding my feet to the fire, as will the hon. Member for Swansea East.

I hope I have reassured colleagues that we are doing so much work in this area. Debates such as this are not just about holding me to account. They are about breaking taboos and having lightbulb moments for women across the country, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) said. I look forward to working with colleagues on both sides of the House and in all four nations to improve the experience for women.

[Mr Laurence Robertson (in the Chair)]

I call Carolyn Harris to wind up.

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[Carolyn Harris]

That is a perfect suggestion, and it is something that has been playing on my mind lately.

[Mr Laurence Robertson (in the Chair)]

Order. This is a winding-up speech and should last only two minutes.

[Carolyn Harris]

Yes, two minutes.

The last thing I will say is that everything that everybody has said is wonderful, but as long as women do not have a single prescription charge, do not have a proper diagnosis and proper medication, are giving up work and do not have equal treatment, we are failing. We cannot continue to fail women.

Question put and agreed to.

Resolved,

That this House has considered the menopause.

Oral Answers to Questions

Laurence Robertson Excerpts

Tuesday 19th April 2022 Commons Chamber

[Edward Argar]

I am grateful to the hon. Gentleman, and had we been going further down the route of privatisation, his question might have had a little more resonance. What we are doing in the NHS in England is investing in our workforce and investing in our national health service, while of course working closely with the independent sector to maximise the use of its capacity in parallel to make sure we bring down waiting lists and waiting times.

[Mr Laurence Robertson (Tewkesbury) (Con)]

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

[The Secretary of State for Health and Social Care (Sajid Javid)]

Our healthcare system is standing at a crossroads, and sooner or later we will have to make a choice between endlessly going back to the taxpayer to ask for more money and reforming the way in which we do healthcare in our country. Last month, I unveiled an ambitious new programme of reform, setting out how we are going to prioritise prevention, offer more personalised care, deliver improvements in performance and back the people making the difference in the NHS. The objective of this agenda is simple: to bring about the biggest transfer of power and funding in decades from our ever-expanding state to individuals, their families and their communities.

[Mr Robertson]

In Gloucestershire Hospitals NHS Foundation Trust, 30% of patients do not medically need to be in hospital; they are waiting for discharge. That figure is twice the national average. Will one of the Ministers contact the relevant people in the health service in Gloucestershire to ask them for ways in which the Government could help them to reduce that figure, because as it stands lives are being put at risk?

[Sajid Javid]

My hon. Friend is right to raise this. We are already in contact with the acute trust in Gloucestershire and some of the other trusts that are finding delayed discharge a particular challenge. My hon. Friend will know that, because of the pandemic, what has been a long-term challenge has become much more acute, not least because of the lost beds due to infection protection control and staff absences both in healthcare and in social care. Our delayed discharge taskforce is making a difference—the numbers are coming down overall—but we will be working with Gloucestershire.

Covid-19: Impact on Social Work

Laurence Robertson Excerpts

Wednesday 23rd March 2022 Westminster Hall

[Jim Shannon]

As my friend, the hon. Member for Glasgow East (David Linden), said—and as I am trying to say, in my broken words—people have to start somewhere in life; they have to start their job somewhere and learn about their role.

Social care organisations have revealed that 75% of social workers feel more negative about their work life in 2021 compared with in the first year of the pandemic. People come to us all the time with problems, and I like that because it is my job. Many people say, “I don’t know how you do your job, listening to people’s complaints and always solving their problems, and so on”, but I reply, “That’s what life is about. Life is about making lives better.” We need to be aware that social workers sometimes deal with complex and difficult issues. My question to the Minister is, has any assessment been done of the impact of the pandemic on social workers? If the figures are right—I understand that they are—that 75% of social workers feel more negative about their work life in 2021, we have a potential problem. I hope we do not, but we must at least consider that and respond.

This situation is down to the increasing pressures and challenges that the social work sector has faced. Referrals of children to social services in Northern Ireland have increased every month since February 2020. The highest figure was in April 2021, with 3,616 children being referred. That clearly indicates that parents are struggling to cope, and is a clear sign of the increasing pressure on our social workers, which the hon. Member for Lancaster and Fleetwood illustrated very well in her contribution, and as other Members have reported.

We must not forget the impact that the covid outbreak has had on the social sector in relation not just to children, but to the elderly and the vulnerable. The hon. Member for Ruislip, Northwood and Pinner (David Simmonds) rightly referred to an issue that is on my mind as well: people who depend on family members to look after their financial affairs. I have dealt with a few of those cases, which are always difficult because there are often two sets of family members saying two different things—but there is a person in the middle who is losing out.

The BBC revealed in mid-2021 that almost 2,000 people in Northern Ireland are waiting for care packages, so that they can be supported to live in their own homes. Just this week, a very lovely man who I have known all my life—he is well into his 80s now—has been ill and had to go to hospital. Although he wants to come home, and would be able to, he needs a care package in place before he can come home because, due to the nature of his disability, his wife would be unable to provide the physical care that he needs. That is not the Minister’s responsibility; I am just illustrating the issue.

The wait for care packages could mean an increase of patients to residential care. My constituency of Strangford takes in the South Eastern Health and Social Care Trust, which has reported that 282 people were waiting from the end of August 2021. Social workers are a key part of making that a success story. The provision of home care is crucial in taking the additional pressure off of hospitals and care homes. We must ensure that our social workers have the capacity to deal with the increasing amount of care packages needed. I have never seen anything quite like it. I know that we are getting older—we are living longer and our bodies are breaking down, meaning that more people need care packages—but there has to be a strategy and a vision for how we deal with that, as has been pointed out in other contributions.

There is an increased risk of covid infection for those who work in the social work industry, as we have seen happen over and over. That is nobody’s fault; it is the nature of life. It cannot be helped when tests are positive and people must take time off work. However, that is where we can step in to ensure that there is a sustainable number of social workers to cope with the level of care needed by children, the elderly, the vulnerable and the disabled.

We must also take into consideration the impact of the pandemic on our social workers’ mental health. Some 55% of respondents to a survey said that they felt increased anxiety—in an already difficult job—given the risk that they posed to the vulnerable by potentially carrying covid. I am keen to hear the Minister’s thoughts on how we can better deal with that. One way would be to have extra staffing, as the hon. Member for Lancaster and Fleetwood mentioned earlier. Social workers are as prepared as they can be in terms of personal protective equipment, as the Government and the Minister have done extremely well in responding to that need, but the Government must step in when it comes to staffing and workload. Many social workers have stated that their casework load has increased by as much as 40% over the pandemic. They are working longer hours—I know that, because they tell me that and I see it—and those longer hours are probably for the same money. Overtime rates will never compensate for the loss of physical wellbeing and mental health.

The Department of Health and Social Care must have provisions in place to ensure that our social workers are not under the most extreme pressure. I very much look forward to the Minister’s response and the encouragement that she will give us. I urge her and her Department to consider the impact of that pressure not only in England, where her responsibility lies, but across the United Kingdom. I know that the Minister, like those in other Departments, regularly contacts her equivalent Minister in the devolved Administrations, be that in Scotland, Wales or, in my case, Northern Ireland, so I know that there is continuity between those Administrations. I say very gently to my two friends, the hon. Member for Glasgow East and the hon. Member for Linlithgow and East Falkirk, that I very much think that within this great United Kingdom of Great Britain and Northern Ireland, we are always better together; we can work together and exchange ideas, and we can all benefit from that. I say that gently to my friends in the SNP, because I know that they really do agree with me that we are better together.

[Mr Laurence Robertson (in the Chair)]

I call Martyn Day.

[David Linden]

How do you top that, Martyn? [Laughter.]

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[Mr Laurence Robertson (in the Chair)]

I call Cat Smith to wind up the debate.

Oral Answers to Questions

Laurence Robertson Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maria Caulfield]

I am very disappointed by the hon. Lady’s question. Serious issues are facing the NHS and patients, and instead of playing party politics at the Dispatch Box, perhaps she needs to ask her own leader what he was doing in May last year.

[Mr Laurence Robertson (Tewkesbury) (Con)]

13. What steps he is taking to help expedite the process of arranging care packages for people waiting to be discharged from hospital; and if he will make a statement.

[The Minister for Care and Mental Health (Gillian Keegan)]

People should be discharged from hospital safely and with the appropriate care and support they need. As the Secretary of State outlined, we have provided £3.3 billion via the NHS to facilitate timely hospital discharges over the pandemic, including £478 million just for this winter. We recognise that providers and local authorities have experienced significant challenges in recruiting and retaining social care workers. That is why we have provided £462.5 million over winter, for this period, to support care providers to improve existing care support.

[Mr Robertson]

I thank the Minister for that response, but even given all that help, almost 30% of available acute beds in Gloucestershire are occupied by patients who are medically fit for discharge. About half of those are awaiting care packages and the other half are looking for beds in community hospitals or care homes, or awaiting home discharge. What more can the Government do to relieve the pressure on the acute hospitals in Gloucestershire and on all the medical staff?

[Gillian Keegan]

I assure my hon. Friend that this is something we take very seriously and we meet every day to discuss this issue. We are conscious of the pressures caused by omicron, and of the herculean challenges faced by health and social care providers to discharge people in a safe and timely way, particularly with outbreaks and having to manage infection prevention and control. That includes the Gloucestershire Hospitals NHS Foundation Trust, which declared a national incident on 28 December at its Gloucestershire site. But it responded brilliantly and stood down the incident nine days later. As the Secretary of State said, we have also established a national discharge taskforce, which is driving progress to bring a renewed focus on reducing discharge delays, including in Gloucestershire, and working with local government and the NHS.

GP Appointment Availability

Laurence Robertson Excerpts

Tuesday 26th October 2021 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission. Please give each other and members of staff space when seated, and when entering and leaving the room.

[Joy Morrissey (Beaconsfield) (Con)]

I beg to move,

That this House has considered GP appointment availability.

It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. The chances of misdiagnosis can increase dramatically if GPs rely on emails or telephone calls exclusively. I speak from experience: for days, my mother-in-law was misdiagnosed as having a urinary tract infection, when she had actually suffered a severe stroke. Precious time was lost, and terrible damage done, because she was not seen by a GP. For every 100 ailments that can be diagnosed safely without seeing a GP, there will be one that cannot—one that could prove to be fatal, which is not a price worth paying.

I thank NHS workers and GPs for working tirelessly throughout the pandemic. I was encouraged to apply for this debate by my constituents, who came to see me again and again about this issue. I wanted to make sure that their voice was heard. I will read out some of their actual cases, because it is important to hear from them about what they have been experiencing. I would say that they are divided into two categories. The first is those who are disabled and perhaps suffer from dementia or other cognitive impairments, who find talking on the phone very difficult, and who really need to see a GP in person. The second is those who are happy to speak over the phone when they need a GP appointment, but find that the IT systems in place in certain GP surgeries cause issues with access to GPs.

The first example is from Marlow. A lady wrote to me and asked for an appointment to see me. She said:

“When I got through to the surgery, we were told that we should have a telephone appointment first. The GPs have my daughter’s number, as she cares for her grandmother. I explained that we do not live with her and cannot sit at her house and wait for a call. Also, there was a phone for her to sit around all day, and no one answers. She isn’t good with IT and has trouble explaining and expressing herself and telling someone what is wrong over the phone. I understand we are in extremely unusual circumstances, but there has to be exceptions, and there must be a way for elderly, and in some cases disabled, people to be able to get an appointment. Many do not have the capability to use the internet, and even phones in some cases.”

That was particularly true in the case of my mother-in-law, who had had a stroke. Luckily, we had power of attorney, but many people do not. I appreciate that the Government have made great strides in this regard, but we need to look at how we can protect those who are disabled, who perhaps have cognitive impairments and who need to have a carer come with them to a GP surgery in order to express what is wrong and explain what condition they have. Greater attention should be paid to this in the future.

We also have the issue of general IT and phone challenges. A resident in Farnham Common wrote to me and said:

“We have difficulty making the initial contact with GP surgeries. Most GPs operate a system which requires the patient to telephone when the surgery opens at 7 am to seek a consultation for that day. In our collective experience, it is often extremely difficult to get through. It takes a very long period of repeated calling. One friend recorded 140 unsuccessful attempts to reach the GP surgery.”

Some of the GP surgeries in my constituency are excellent. They were excellent during the vaccine roll-out and through covid, but we have certain GP surgeries that have had challenges meeting residents, challenges with the vaccine roll-out, and challenges in general throughout the covid period. Quite a number of residents have written to me and spoken to me about Burnham Health Centre, so I want to share specifically the IT challenges that it seems to face consistently.

One resident, Colin, said that if you are lucky enough to be 29th in the queue that morning at 7 am, you may get a message that says no appointments are left for the day. You can hang on in silence, or you may get to speak to a person—you may get through to a human being. You are told that there are no appointments and that you need to use Patient Access. When you try to book an appointment via Patient Access, it gives you possible ways to book, but only for things like contraceptive appointments, and nothing else. When Colin tried to access Patient Access, he was given an electronic form which he completed several times. It kept coming back saying that it could not be processed. He tried dozens of times and finally gave up and decided that Patient Access was not working.

He was not the only resident in Burnham who complained about Burnham Health Centre and Patient Access; several more wrote to me about the same issue. One said:

“I do think it’s ridiculous that you cannot get an appointment when you call, I am happy to wait a day or two, if it is urgent, there is always 111. The practice of releasing a limited amount of appointments at a certain time is not fair and just causes a bun fight. I do think the staff would benefit from customer service training”—

for everyone’s benefit.

A set amount of appointments are on a first-come, first-served basis. This seems to be unique to this GP surgery, but it has become a very agitating issue for people in the area who already suffer from some health inequality. They perhaps do not have the financial ability to go privately. Many are older and vulnerable, and it is demoralising that they often cannot get hold of a GP for even a phone call and consultation. Just getting a phone call would be a positive step in certain cases in my patch.

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[Margaret Greenwood]

Does the hon. Lady share my concerns about the provision in the Health and Care Bill for the assessment of patients to take place after they have been discharged from hospital instead of before, as happens at the moment? I have very serious concerns about that issue. I tabled a couple of parliamentary questions, which were answered by a different Minister to the one who is here in Westminster Hall today. One question was about the fact that this discharge-to-assess approach has been going on under the Coronavirus Act; I asked how many patients had been discharged that way. The reply came back that 4 million patients had been discharged from hospital without having their assessment. I asked how many of those had been readmitted within 30 days; the Minister replied that the Government did not know because the information was not held nationally.

This is a very serious concern, because we are talking about vulnerable people. I know the hon. Member for Beaconsfield is talking about a particular relative. The idea that somebody with dementia, or early-stage dementia that has not been fully diagnosed yet, should be discharged before their needs are fully understood is very alarming. An independent review of this is going on at the moment, and I would be grateful if the Minister could give us an idea when that is going to be published. It is meant to be this autumn. I would like to raise this with the Minister as a very serious issue and wondered if she would like to comment on it.

[Mr Laurence Robertson (in the Chair)]

Order. I remind hon. Members that interventions need to be brief.

[Joy Morrissey]

I recall the Member speaking on this topic previously. I commented only because of my personal experience. The change is well intended, and I understand where it is coming from, but for a disabled person, and for someone who cannot advocate for their own care needs, having a care plan in place before leaving hospital helps with accountability and the structure of the care. From my own personal experience, as someone who has taken care of a very disabled relative who cannot advocate for herself, I can only say that having this agreed before she came out of hospital made it easier for our family to co-ordinate the care. It is difficult to know which funding pathway is linked to what care once someone leaves hospital; there is a statutory responsibility, but then there is the question of who picks up the care once that period out of hospital has finished. For someone who is disabled, has had a stroke or requires long-term rehabilitation, that is a very sticky issue because whichever organisation within the health structure picks up the statutory duty picks up a huge cost. I think it is a very nuanced issue and we need another debate on it to flesh out all the different challenges. However, I take on board the comments made by the hon. Member for Wirral West and recall supporting what she said when she spoke several months ago.

I understand that these are unprecedented times, and there are great challenges for everyone across the health sector. This is not to criticise anyone; it is just about how we can positively move forward into the new covid era in which we find ourselves, and into the winter months when there are more challenges. It is about how we can work together to find solutions, particularly for the vulnerable, the disabled and those who cannot advocate for their own care needs. I am very grateful that we have been given time to debate this topic.

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[Several hon. Members rose—]

[Mr Laurence Robertson (in the Chair)]

I ask hon. Members to now limit their speeches to six minutes, so that we can get everyone in.

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[James Sunderland (Bracknell) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Beaconsfield (Joy Morrissey) on securing the debate. I listened to the speech by my hon. Friend the Member for Waveney (Peter Aldous)—I am sure he was looking over my shoulder when I wrote mine, because some of the themes are quite similar.

I find myself in the curious situation of raising the issue of NHS services in east Berkshire. Why is that curious? Because we are pretty well served, actually. The NHS is pretty good locally. We have three fantastic hospitals on the doorstep. The Frimley ICS is one of the best-performing care systems in the country and recently had a reprieve from the new Health Secretary, who had looked at breaking it up. We are in a pretty good place, and I do not tend to get letters from constituents about the healthcare that they receive, which is very good. In this case, however, I have been receiving letters, and I am quite concerned about it.

What is the perception, and what are people saying to me? Under the current policy, GP practices must now ensure that they offer face-to-face appointments. Only 57% of appointments across the UK are currently face to face, versus 79% before the pandemic, so there is an issue. There is also a perception that it is difficult to get through to practices on the phone, and that there is low availability of appointments and a lack of face-to-face care. Constituents are never wrong, my constituents are not wrong, and if they are writing to me repeatedly about these issues, clearly it is incumbent upon me as their MP to raise them.

What is the good news? Nationally, the narrative is actually very positive. If we look at the current statistics from the Care Quality Commission, the scores on GP access are the highest they have ever been, with a 67% satisfaction rate now, compared with 63% last year. Same-day appointments have gone up. People are satisfied with what they are getting from their GP, with an 88.7% satisfaction rating of “good” or “very good”. As of August 2021, 23.9 million GP appointments were offered and recorded, compared with 23.4 million two years ago, so things are getting better. Things are going up. That is in addition to the 1.5 million covid-19 vaccination appointments delivered in August 2021 by GP surgeries. The service, statistically, is improving. It is good news.

However, the data appears to contrast with what I am hearing locally. I agree with what my hon. Friend the Member for Bolton West (Chris Green) said earlier about how there could be a postcode lottery, or it could be related to the service provider at individual constituency surgeries. Demand is clearly outstripping supply, so Houston, we’ve got a problem.

As an example, one constituent spent 45 minutes on the phone to a particular surgery, tried 159 times to get through and was then offered a telephone consultation for a lump on her neck, which is not great. Constituents have dialled 111 and been advised to contact their GP, then after being unable to get through, they phone 111. We have had multiple complaints from certain constituents in a certain part of my constituency—it would not be fair for me to say where—informing me that the practice has 20,000 patients and only two doctors. The figures do not work. Telephone triage is being used instead of an immediate face-to-face. For flu vaccinations, one particular group practice is advising constituents to travel to the central hub in Bracknell, which causes issues for those less able to get there. We have a capacity problem.

However, it is unacceptable that staff are working under challenging circumstances and facing levels of abuse not previously seen. GPs and staff are working harder than ever before. Retention and staff satisfaction are an issue. Therefore, MPs like me must do more to help to redress that balance, and to balance the narrative. By the same token, GP surgeries also need to take the inquiries that we raise with them more seriously. The GP is not the enemy, and nor is the MP.

My general advice to GP surgeries is this: I think that there are things we can do. We need more staff. Let us do more to recruit staff, particularly receptionist and telephone staff. We need to reassure patients a bit more; they want some TLC after the pandemic, and it is right that they get it. We need to sort out the phone lines. We need to improve electronic referral systems. In Bracknell, we have the new primary care network phone system, whereby calls that cannot be answered by a particular surgery will be rerouted to another, which is quite exciting. We also need communication between surgeries and their patients: tell the constituents what is going on and explain to them why their calls are going unanswered. MPs need to visit surgeries, as I am next week. Basically, let us improve customer service.

I have three points to conclude with. First, care providers in East Berkshire and across the country are working miracles, but are accountable to their customers. I would urge GP surgeries to think about what their customers are saying to them, and to do what they can to reassure them. My second point is addressed to the Minister. The new IPC guidance is forthcoming. When will it be published, and when will GP surgeries get more guidance on what it means? Lastly, I urge everyone listening to this to watch the language being used. We are all in the same space and working hard; doctors and staff are working really hard. Let us please tone it down. All of us are part of the problem, but we are also all part of the solution.

[Mr Laurence Robertson (in the Chair)]

We now come to Front-Bench speeches. I would like to leave a couple of minutes at the end for the mover of the motion to wind up.

Oral Answers to Questions

Laurence Robertson Excerpts

Tuesday 8th June 2021 Commons Chamber

[Ms Dorries]

There is emerging evidence on the mental health benefits of mindfulness, which can take the form of meditation or wider approaches that incorporate a mindful approach. As the hon. Lady may be aware, I have been particularly concerned that we separate out mental illness and wellbeing and mindfulness. We should focus on mental illness, which needs intense clinical intervention in NHS services, but also look at mindfulness and wellbeing. That is why I mentioned “Every Mind Matters”: the facilities are there.

[Mr Laurence Robertson (Tewkesbury) (Con)]

What steps he is taking to increase the range of work carried out by pharmacies.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

The pandemic has proven to the public how vital our highly skilled pharmacy teams are in supporting their communities. Pharmacies have massive potential to build on the new services they are already delivering, and we will continue to look at how we can use them further.

[Mr Robertson]

I thank the Minister for that answer. Can we also make sure that the public are aware of everything that pharmacies can do, so that they can use them to take pressure off GPs?

[Jo Churchill]

Indeed we can. I would be honoured to work with my hon. Friend to do that so that people think “pharmacy first”. Pharmacies are delivering lateral flow devices into our communities; 500 of them have stood up to be vaccination sites; and we can now refer from NHS 111 and GPs into community pharmacies for the supply of prescribed medicine and for minor illnesses. We need our pharmacies to show their skill base; they are a highly skilled group that we should all be asking to do more and celebrating.

Maternal Mental Health

Laurence Robertson Excerpts

Wednesday 10th March 2021 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. Members participating physically and virtually must arrive for the start of Westminster Hall debates and are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically are asked to clean their spaces before they use them and before they leave the room.

--- Later in debate ---

[Tim Loughton (East Worthing and Shoreham) (Con)]

It is good to see you in the Chair, Mr Robertson, in this new Chamber, which is a first for us all. I congratulate the hon. Member for Richmond Park (Sarah Olney) on securing the debate. It is good that we have had a number of debates in recent months about maternal challenges during the pandemic, the impact on families and the impact on the mental health of parents and children. There is little that is more important, frankly. It is something that we will have to spend a lot of time concentrating on as we build out of the pandemic in the coming months.

Let me declare my interests. I am chair of the all-party parliamentary group for conception to age two: first 1001 days. Given the hon. Lady’s comments, I think we have a new recruit. If she is not already one of our members, I would be delighted to welcome her along. It is a very active group. I also chair the all-party group for children, and until recently I was the chairman of trustees of the Parent-Infant Foundation charity, which concentrates on the initial 1,001 days and the attachment between parent carers and their children.

I was impressed by the response from the digital teams in the House. It was a very good exercise. As the hon. Lady said, 11,265 responses is not to be sniffed at. Alas, the responses were all too familiar. We have heard similar anecdotes from our constituents about what has been going on during lockdown. There were responses about parents, and particularly mums, feeling lonely. They feel isolated in hospital, particularly if they have to stay in for any length of time because of complications. They have problems even getting their partners—the fathers—to be able to visit them. They feel isolated from family support networks that we normally take from granted. They feel isolated from new mum and baby groups. One of the respondents to the survey called them a safety valve where completely new mums, in particular, learn from other mums—either new mums or experienced mums—and the babies interact too. It was interesting that, for colleagues who gave birth during the lockdown, it was several months before their babies were actually able to meet another baby, and there was a bit of a shock factor there. We perhaps underestimate the impact of that social contact from the very earliest stages after a child is born.

In particular, as the hon. Lady mentioned, there is the isolation from health professionals on a face-to-face basis. I know that there have been a lot of substitute virtual visits, but they are not a substitute and they must not become the norm. We need to build back our health visitor numbers, as we did so well in the coalition Government between 2010 and 2015, when we produced 4,200 additional health visitors, who were absolutely invaluable. They are the friendly face that new parents will welcome across a threshold, where they may be more suspicious of a social worker or other care workers. They are also an early warning system for problems that may be going on with a new parent and ultimately any safeguarding issues.

A report that the First 1001 Days Movement produced last year, called “Working for babies”, said that services supporting nought to twos were highly depleted during the first spring lockdown last year. The majority of services for nought to twos did not bounce back quickly as lockdown measures were eased. We need to make sure that mistake is not made again this time.

This lockdown has been especially stressful for first-time mums, single mums, and families having to balance working remotely, new forms of working and working covid-safely, and juggling home schooling if they have other children too—thank goodness all my children are above school age and we have not had that additional challenge. Even before the covid pandemic, at least one in six mums suffered from some form of perinatal mental illness—commonly anxiety disorders and depression. We know that the pandemic and lockdown have impacted on the mental health of just about everybody, but particularly on that cohort of mums.

A survey by the excellent baby charity Bliss found that, among its members who had received neonatal care during the pandemic, 90% of parents said they felt more isolated as a result of having a baby in neonatal care during the pandemic; 70% said their mental health was negatively affected as a result of the experience; 56% said the mental health of their partner and wider family had been affected; and 47% said they were not offered support for their mental health while their baby was in neonatal care. We know that, in extremis, suicide is the biggest cause of maternal death. We must do so much more to ensure that women do not get in that position and that support is there and accessible.

The shortage of health visitors is a false economy. I have always said that; we had a debate specifically on that last year. I pay tribute in particular to Cheryll Adams, who set up and has led the Institute of Health Visiting. She is retiring at the end of the month. The service she has given to that area has been extraordinary and has informed many debates in this place. I put on the record our thanks and gratitude to her.

There is also the whole issue of increased domestic abuse during pregnancy. The figure that I always find hard to take on board is that a third of domestic abuse happens during pregnancy as well, and we know that domestic abuse has gone up during the pandemic, so all the additional pressures on women who are about to give birth or who have just given birth are extraordinary.

The cost of perinatal mental illness, as calculated by the Maternal Mental Health Alliance some years ago—it still holds true, and today it is probably an underestimate—was £8.1 billion each and every year. On top of that, the cost of child neglect is £15 billion, so we as taxpayers are paying £23 billion-plus into the health service to get it wrong. To prevent us getting it wrong, if we spent a fraction of that on the support services—the health visitors and those networks—being there in the first place, that would be money well spent and well saved.

Of course, the key is good attachment between babies and their parents or primary carers from those very earliest stages and during conception, hence the founding of the First 1001 Days Movement. My right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) launched the 1,001 critical days manifesto back in, I think, 2012, which was signed up to by colleagues across parties, the royal colleges, clinicians, academics and children’s charities alike. It is still relevant today.

To quote research by the First 1001 Days Movement and the Parent-Infant Foundation—I pay tribute in particular to Sally Hogg, who does so much of the good work there—it is estimated that 10% to 25% of young children experience significantly distorted relationships with their main carer or carers, and from that a range of poor social, emotional and educational outcomes in childhood and across the life course can be predicted. Maternal mental illness in pregnancy and the early years of a child’s life can have adverse effects on the child’s brain development and long-term outcomes. Maternal mental illness can affect children both directly and indirectly. For example, exposure to stress hormones in the womb is thought to affect the child’s developing stress response systems, and mental illness after birth can affect a mother’s ability to care for her baby, her parenting style and her developing relationship with her baby. Even relatively mild mental illness, if untreated, can inhibit a mother’s ability to provide her baby with the sensitive, responsive care that they need.

This, again, is a statistic that I always use. If a 15 or 16-year-old teenager is suffering from some form of depression or low-lying mental illness, there is a 99% likelihood that that child’s mother suffered some form of perinatal mental illness—the connection is that close. So why are we not doing more to support the mother before and soon after she gives birth? The implications of not doing so will be with her child and her for many years to come, and often into adulthood for the child.

It is also important to note that although perinatal mental illness increases the risk of disruptions in early relationships, they are not inevitable. Some mothers can continue to give their babies the sensitive, responsive care they need, particularly with the right support—and good, effective support can be had, if it is available. That is the problem: it is not always there, or not always there at the right time or in the right place.



Other risk factors put early relationships and infant mental health at risk, including families where fathers or other care-givers have serious mental health problems themselves. Again, we underestimate the impact of becoming a father, particularly for the first time, on the mental health of dad. In most cases this is a joint partnership, but fathers often get overlooked. They often get excluded from the whole neonatal process within hospitals, as well. They need looking after too, because if they can be looked after, they can look after their partner and there is a mutual benefit from all of that. We need to do more for fathers.

The NHS long-term plan includes a commitment to expand access to evidence-based parent-infant interventions within specialist perinatal mental health services, which is indeed welcome. It will ensure that attention is given to the parent-infant relationship alongside the mother’s own mental health when mothers have moderate or severe mental health problems. We must not just look at the child or the mum in isolation; we are looking at the bonded family.

However, access to mental health services for babies should be dependent on the risks to their mental health and not contingent on other factors, such as their mother’s mental health needs. So, the NHS long-term plan for England also committed to improving access to specialist services for all children from 0 to 25, but delivering that commitment requires specialist provision for all babies who need it, as they are children, too. Such provision would need to be delivered by parent-infant specialists. However, the NHS long-term plan says nothing explicitly about specialist mental health services for the youngest children in their own right.

The solution is that we need specialised parent-infant relationship teams providing therapeutic support where a baby’s development is most at risk due to severe, complex and/or enduring difficulties in their relationships. Such teams focus on the relationship between a baby and his or her parents or care-givers as the main way to improve infant mental health. However, there are fewer than 40 specialised parent-infant relationship teams in the whole of the UK, and most babies live in an area where these services just do not exist; vast areas of the country have no provision.

One of the aims of the Parent-Infant Foundation charity, which was set up by the right hon. Member for South Northamptonshire, is setting up parent-infant projects around the country, where practitioners are available, to work on the attachment of parents and their children. We just need it to be mainstream across the whole of the national health service.

As the Royal College of Psychiatrists has said, the need for more perinatal psychiatrists to work in these services is crucial. These specialist services need a highly trained specialist workforce, but the workforce census in 2019 showed that 13% of consultant and perinatal psychiatrist positions remained unfilled. Without more psychiatrists, ambitious plans to transform and expand services will be put at risk.

We are soon to have the Leadsom review, if I may call it that; it does not really ring true as “the South Northamptonshire review”. The right hon. Member for South Northamptonshire is producing the review; hopefully it will be published later this month. I have been privileged to play a part in it, and chaired a parliamentary advisory group.

Absolutely key to that review are a joined-up support service between the NHS, local government and other key professionals, to give that wraparound service to parents in those crucial early months and years; a digital record, so that all those professions are working from the same information, rather than every visit to mum being a new visit; and a national template of the quality that we need to reach, but with local implementation, so that a service in Richmond, although it may look a bit different from a service in my part of the world on the Sussex coast, is none the less required to produce quality outcomes and clear the same threshold.

We look forward to that report in the coming weeks and months, and I very much hope that the Government will take it on board and produce the goods, because little, if anything, is more important than the welfare, good health and good mental health of our children. And a child is given the very best opportunity—the best start in life—if their parents are in a safe and stable place as well.

[Mr Laurence Robertson (in the Chair)]

In order to call everyone, I wonder if I might ask all Back Benchers to stick to around five minutes in their contributions, please.

Covid-19 Update

Laurence Robertson Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

First, I urge the hon. Lady to look at the figures published this morning, which show that the majority of tests when done in person are now turned around within 24 hours across the country, and capacity has increased radically. What I would ask of her for the future, to help the north-east get out of tier 3, is to work with her local councils, with the directors of public health, to embrace the community testing that has been effective in Liverpool. If they are up for doing that—it has to be in consultation and conjunction with the local council, because they know the area—I very much hope that they will come forward to pick up the baton and make that happen.

[Mr Laurence Robertson (Tewkesbury) (Con) [V]]

This is not an easy question, but how will the Health Secretary take into account the wider mental and physical health implications for people who are prevented from living their lives as they would wish to live them?

[Matt Hancock]

We look as much as we can at taking the impacts into account. For instance, the mental health of people under lockdown is of course more challenged than in normal circumstances. We balance that against the impact of covid both directly and in filling up the hospitals on the healthcare that we all get for all the other conditions that exist. It is a difficult balance to strike. On the particular impact on mental health, which my hon. Friend raised, the Royal College of Psychiatrists has done very interesting work to understand the nuanced balance between the impact of covid on people’s mental health and the impact of lockdown. Both are significant and I commend its work to him.

Coronavirus

Laurence Robertson Excerpts

Tuesday 15th September 2020 Commons Chamber

[Matt Hancock]

I am very happy to meet the campaign. Of course I have seen the reports. I feel very strongly about this. We have worked very hard to get through the backlog, and we are making progress against that backlog. Nevertheless, I am happy to look at anything we can do to speed that up, so I look forward to listening to the details of what we can do.

[Mr Laurence Robertson (Tewkesbury) (Con)]

As my right hon. Friend knows, sporting venues are suffering financially because of the restrictions, and it does not help when planned pilot events are cancelled at the last minute. Who takes the decisions on whether to allow pilot events to carry on—is it done centrally, locally or a combination of both? There is a feeling that there is some confusion.

[Matt Hancock]

My colleague the Culture Secretary is responsible for the programme of pilot events. For a pilot event to go ahead, it needs both the support of the local council and to have been advised as covid-secure by Public Health England. The Department for Digital, Culture, Media and Sport takes the lead. As the MP for Newmarket—one of the four towns in my constituency relies on sport, as do the livelihoods of thousands of my constituents—of course I understand the impact, in exactly the same way that my hon. Friend does, as the MP for Cheltenham racecourse. I speak a lot to the Culture Secretary and the Prime Minister about this subject. I hope that we can get as much going as fast as possible, but safely.