Mental Health Support: Frontline Staff
Lisa Cameron Excerpts(3 years, 6 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I beg to move,
That this House has considered mental health support for frontline staff.
It is an honour to move the motion with you in the Chair, Mr Paisley, now that Westminster Hall is once again available for our purposes. In this unique time of pandemic, the mental health of frontline and key workers should be fully supported. I declare an interest as a former psychologist in the NHS for 20-plus years—I am showing my age—before I came to this House, and as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.
No one should underestimate the severity of the mental health crisis that engulfs us all as a direct result of the advent and ongoing havoc wreaked by covid-19 across the UK, and indeed worldwide. I thank the organisations that have been involved on the frontline, supporting mental health strategy and the delivery of services, including: the child mental health charter and, in particular, Helen Clark, a former Member of this House; the British Psychological Society; the British Medical Association; the Royal College of Psychiatrists; Mind; the Centre for Mental Health; and EveryDoctor—that is to name but a few. I thank all the other parliamentarians who have taken the time on a Thursday afternoon to speak on this vital issue.
On 5 October, Dr Tedros Ghebreyesus of the World Health Organisation introduced the first global dataset on covid-19 access to mental health services. He said:
“COVID-19 has interrupted essential mental health services around the world just when they’re needed most.”
There were some devastating findings. Before the pandemic, countries were spending less than 2% of their national health budgets on mental health. More than 120 countries —93%—reported that mental health services had been stopped or disrupted during the pandemic, 72% said that mental health services to children and adolescents had been disrupted, and 75% had seen a disruption to mental health services in the workplace. Despite the fact that 89% of the countries surveyed said that mental health and psychosocial supports were included in their national coronavirus response plans, only a shocking 17% had full additional funding to cover the cost of those services. Together, those figures show that there is likely to be an international tsunami of mental health morbidity like no other seen in our time.
The Centre for Mental Health, a UK charity, estimates that in England alone up to 10 million people may need mental health support—including long-term support—for the foreseeable future as a result of covid-19, and that 1.5 million children may require support. Those numbers are a stark warning that the impact of the pandemic will have severe long-term repercussions for the mental health of the UK as a whole.
Those affected will need support for depression, anxiety, post-traumatic stress disorder and other mental health difficulties in the coming months and years. Of course, some groups are disproportionately affected, including those with disabilities, those from minority ethnic communities and those with pre-existing mental health conditions who have experienced increased morbidity during the pandemic. Responding to increased mental health needs must therefore be a priority when a recovery plan is drawn up for both NHS and social care sectors for the future of our public health and in fiscal planning across Governments.
On the impact on frontline staff, the national forecast for adults is that more than 200,000 NHS workers may need treatment for post-traumatic stress disorder, psychological distress and burnout. Although less data has been collected, it is likely that a similar pattern will affect those who work across social care settings such as nursing homes. Research is badly needed. Those staff must not be excluded from or let down by the data collection and resourcing that is required. I would be grateful if the Minister looked specifically at the resourcing of data on the psychological impact of covid-19 in the community, nursing and social care sectors.
The International Council of Nurses reminds us that the effects of covid-19 on the mental health of nurses and the wider health social care workforce is a ticking time bomb. Every Thursday, across the UK, we were glad to show our support for key workers on the frontline, who risk themselves daily as they confront the pandemic on our behalf, but we owe them much more than weekly applause, and Governments across the UK owe them that duty of care.
Data from previous pandemics analysed by the British Medical Journal shows that post pandemic, healthcare workers are at high risk of both psychological illnesses and physical outcomes. For frontline staff, decisions made during the pandemic have regularly determined who to prioritise for care, but they have also felt a lack of control, especially when patients are care home residents who are dying and no treatment has been available for them. Emotionally and physically, having to be there day in, day out for patients as well as their families, who often could not visit relatives in their time of need, has been unduly toiling. That has come alongside the use of personal protective equipment for long periods; times when PPE has not been provided to the extent that it should have been; and long periods of excess working hours, stress and exhaustion.
A study by Kisley and colleagues has identified risk factors for psychological distress for staff in the time of covid-19. Personal care and socioeconomic stressors included personal childcare needs, having an infected family member at one point during the pandemic, and having a lower household income, with fewer choices in how to cope. Trauma is triggered when trusted bodies act in a way that can harm their safety at work, such as the failure to obtain correct or sufficient PPE, or by the breakdown or absence of testing and systems. The study also identified enforced redeployment to care for covid-19 patients, a failure to screen and triage healthcare workers for mental health needs prior to the pandemic, and a reliance on crisis intervention when symptoms develop.
Prior to the pandemic, the British Medical Association set out in a 2019 NHS staff survey that 40.3% of healthcare staff reported feeling unwell due to work-related stress. With the onset of covid-19, the workload for healthcare workers has increased radically. Four in 10 psychiatrists have reported an increase in people requiring emergency healthcare, including new patients, in the aftermath of lockdown. NHS and social care jobs obviously involve exposure to a huge range of potential stressors, including competing demands, interpersonal conflict, complex and life-changing decision making, moral injury, shift work and long hours. Added to that in the past six months is the pausing of the working time directive, the limited scope for time off or holiday periods, the increasing morbidity of patients, and losing colleagues. As someone who has worked in the NHS for many years, I have to say that the loss of colleagues is a terrible shock, and not something that people expect in their day-to-day working lives. That is something that frontline staff have had to cope with in addition to their care roles.
People join the caring professions to make a difference and make others better, but coronavirus has created an overwhelming feeling of helplessness in the midst of this trauma. It should be noted that previous coping strategies that those on the frontline utilised may play out differently if they have to cope with a second or third wave. The adrenaline with which they coped in those vital months so that they could be there to support those in need may be replaced by the dread of going through it all again and the fear of being retraumatised.
I have referred to some of the facts and figures impacting the mental health of care workers, but here are some voices from the frontline, expressed in letters sent to The Guardian and the nationwide EveryDoctor organisation, which has been in touch. One said: “The mental health exhaustion that comes from changing everything about the way you work on a weekly or sometimes daily basis for months is immense. All the while, you can see a light at the end of the tunnel, but then you are bracing yourself for the next disaster: a second wave or winter crisis, alongside mass staff absence.”
Another said: “There is the effect of not only seeing patients die, but losing colleagues. Everyone is struggling with this pandemic, but doctors are responsible for the decision making clinically. We can see that this is not going away. There is no respite in sight.”
Another said:
“I am employed on mental health wards as a support worker, helping people recover from acute problems… Covid-19 has not only affected general hospitals but has also had a huge impact on mental health facilities, which are more often run by a skeleton staff… On top of this we are also dealing with mental health patients infected with Covid-19… As we are not considered to be on the frontline, we are not equipped with proper personal protective equipment. We get a basic face mask, gloves and a flimsy apron.”
It should not be forgotten that school staff are also on the frontline, as they have to deal with the effects of the pandemic on children in their care. The mental health issues incurred by lockdown in the children they teach everyday are present upon return to schools. Anxiety and stress among a large group of pupils, alongside the experience of bereavement and a lack of community adolescent mental health services for those with acute problems, has been a feature of the recent past. That is alongside reduced assessment and diagnosis possibilities, due to staff having to change their working patterns, often from face-to-face to virtual sessions, after a period during which sessions were not offered.
Innovation will be key in ensuring that we can address the needs not only in the population but among the frontline staff who desperately need support. Using technology and ensuring that there is the capacity and technical knowledge to support the transition to other methods of care will be fundamental. Meeting the mental health needs that arise from coronavirus is a huge challenge, but it is not optional. Just as responding to the threat of the virus itself has tested our resources and resilience, so too will addressing the psychological and emotional consequences.
I am extremely grateful to the British Psychological Society, which has provided specialist guidance. I know that it has also been working with the Scientific Advisory Group for Emergencies and with the Minister’s office. It wants to see the planning of psychological support and resourcing of the psychological workforce to meet demands in the NHS and care homes and also in schools and the community. It also wants to see increased access to an in-house employee wellbeing service, which it believes will be critical, particularly if unemployment issues face the population in the coming months. It wants to see the employment of psychologists to focus specifically on staff. It tells me that it is not feasible, in the long term, to ask psychologists to work with patients in their work time and then to work with NHS staff in their spare time to meet psychological needs. The society would like to see more use of psychologists not just in supporting patients, but in a strategy to support staff over the long term.
My hon. Friend the Member for Midlothian (Owen Thompson) will be covering in depth the work of the Scottish Government in relation to mental health strategies during the pandemic, so I will focus on the issues that have been raised with me in my capacity as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.
These are some of the questions that I have been asked to raise with the Minister. What steps is the Department of Health and Social Care taking to model and plan for demand for mental health support as a result of coronavirus and the consequent impact on the economy and employment? What additional funding will be made available to mental health providers to ensure that services are covid-19 safe and that they can meet increased demand for support and deliver on existing pledges in the NHS long-term plan for mental health? What resources will be made available for local initiatives that provide early mental health support in our communities, especially for those people who have been bereaved? What proportion of schoolchildren will benefit from the wellbeing for education return funding? How will children’s mental health be supported moving forward?
What resources will be made available to support health and care staff in the NHS, social care and voluntary sectors who are experiencing post-traumatic stress disorder, high levels of psychological distress or burnout? What specialist support will be made available? What resources will be made available to ensure that research and funding are provided for those working in social care settings so that we adequately address their mental health needs alongside the NHS staff population?
What plans are being put in place to protect NHS staff from a potential onslaught of claims against them because of the pressures that they have worked under during the pandemic? That may give rise to a number of negligence suits in the future. That issue has particularly been raised by the Medical Defence Union, which is concerned that staff have often been placed on the frontline with a lack of resources and with a lack of support medically or clinically themselves.
Now is the time when I feel that I and other hon. Members should be responding in the main Chamber to a detailed statement from the Government about their proposals for mental health directly arising from the devastating impact and ongoing effect of covid-19. Such a statement could include ways in which the Government propose to protect and sustain the mental health and wellbeing of key workers and that will be distinctly and separately resourced, rather than relying on any money from pots designed for other purposes. I look forward to the Minister’s reply today. I hope, on behalf of the key workers for whom I have been given the privilege to speak, that she will tell us that the Government have set a date for the announcement of a properly and realistically resourced mental health strategy that will be both integral and central to the overall covid-19 recovery plan.
Ian Paisley (in the Chair)
I thought I was going to be calling Jim Shannon to speak today, but he is not here, as we know, so I call Owen Thompson.
Dr Cameron
Thank you, Ms McDonagh, and I thank everyone who has spoken. It is vital that we continue to raise awareness of mental health, particularly for frontline workers. Saturday is World Mental Health Day, so it is apt that we have spoken about the issues today. The fact that 2 million people have downloaded the Every Mind Matters app shows that the population are reaching out for mental health support, that mental health is at the front of their minds and that they want support to build their resilience.
It is absolutely correct to view mental health as a continuum, but something such as a pandemic can push people who were perhaps coping well previously towards the end of the continuum where they need additional support. Those supports have to be stepped and matched to their clinical needs. Some will have acute clinical needs, and others will be able to cope with the support of family and friends or colleagues, and in different ways. Support needs to be matched. We need to ensure, right across the UK, that best practice is shared; that people work together so that when something is rolled out, it works extremely well; and that there is dialogue and sharing for all staff in the NHS of the four nations.
Before I finish, I want to mention that next year—when we have events back, which I hope will be towards the summer—the all-party parliamentary health group will host awards for staff who have shown themselves to have supported others, whether patients or their communities. I would be so pleased if the Minister and the shadow Minister were able to attend. I can let them know about it well in advance.
I also want to bring up something that I wrote to the Prime Minister about, which I hope to hear about at some point in the near future and which can perhaps gain cross-party support. That is to have a national memorial for those who served on the frontline and lost their lives during this pandemic. I hope that is another discussion that can be taken forward from today.
I thank everyone who took part. I know it is late afternoon on a Thursday, but it is so vital to pay tribute to all those on the frontline who have been there to support our needs in this time of crisis. We must always be mindful of supporting their needs, too.
Question put and agreed to.
Resolved,
That this House has considered mental health support for frontline staff.
Coronavirus
Lisa Cameron Excerpts(3 years, 7 months ago)
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Matt Hancock
That is an incredibly important subject, as we need to make sure we get the screening available. It ties into the questions on testing, because prioritising testing for those about to have NHS procedures, be they diagnostic, such as screening, or an operation of some sort, is so important, for instance, in making sure that we tackle the backlog in cancer cases that inevitably built up. We are tackling that backlog and it is down by about half. I am happy to work with my hon. Friend and all others in this House to make sure that people get the early diagnosis of cancer that can so often be lifesaving.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) [V]
The Secretary of State will be aware of a recent survey which found that one third of children feel more anxious, sad and stressed now than before lockdown. The charity Action for Children has therefore asked the Government to prioritise children’s mental health in covid-19 recovery planning and provide adequate funding to meet this demand. Could he tell the House exactly what he has done about that and when we can expect him to announce a covid recovery mental health strategy?
Matt Hancock
This is an incredibly important subject, and I commend the hon. Lady for raising it and for her work on it, along with many Members across the House. We are putting more funding into mental health, and paediatric mental health in particular, to ensure that we tackle the inevitable consequences of the pandemic.
Covid-19 Update
Lisa Cameron Excerpts(3 years, 9 months ago)
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Matt Hancock
If people go to a shop, then it will be mandatory from 24 July to wear a mask. If they go to a hospitality venue, then it will not.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) [V]
As chair of the all-party group on disability, I am concerned by results from the charity Scope, which has undertaken research showing that one in five adults with a disability has said they will not leave their house until a vaccine for covid is developed, while just 5% said they would feel safe when shielding is paused. What steps will the Secretary of State take to ensure that people with disabilities are protected, but also given confidence to resume their lives after lockdown so they do not slip further into social isolation and loneliness?
Matt Hancock
The hon. Lady raises an incredibly important point, and she has rightly raised this point before. It is so important, especially as we lift the shielding measures at the end of this month, that people who have been shielding have the confidence to know that we are able to lift those measures because the rate of transmission of this virus is so much lower now. It is safe—indeed, it is recommended—that they go out and about. Many charities, including many that we have funded through this crisis, are available to help and support people in these circumstances. She is right to keep raising this issue, and we must keep working on it.
Coronavirus Update
Lisa Cameron Excerpts(3 years, 9 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
Lisa, we cannot hear you. We will come back to you at the end. We will try to sort out the technical problem.
Dr Cameron [V]
Thank you, Mr Deputy Speaker. As chair of the all-party parliamentary group for disability, I have been hearing concerns from those who may be exempt from wearing face masks but are fearful of being confronted because not all disabilities are visible. Will the Secretary of State join me in congratulating East Kilbride’s Hannah Kelsall on developing free “chase the rainbow” carry cards that explain this exemption? Ultimately, no one should ever be challenging vulnerable people outside. It takes a lot of courage for many to leave their homes, but these innovative cards are providing reassurance for many across my constituency and beyond.
Matt Hancock
It is very important that, as a society, we look out for the most vulnerable, especially through this epidemic. The initiative that the hon. Lady describes is just one way in which we can all support people who have particular circumstances, and it relates directly to the introduction of the mandatory use of face coverings in shops, because there are important exemptions. It is important that people are able to express that they have an exemption because of their medical condition requiring them not to wear a mask, so that they can still shop.
Coronavirus
Lisa Cameron Excerpts(3 years, 10 months ago)
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Matt Hancock
Co-trimoxazole is another the prospect that we are looking at, but I am afraid that, as with my answer to my right hon. Friend the Member for Wokingham (John Redwood), the timing has to be driven by the science. If we get success, when a result in which the clinicians have scientific confidence can be met, we will stick with the clinical trial methodology that leads to concrete results. Too many other places around the world have pulled clinical trials early because of promising results that have turned out not to be well founded.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) [V]
The Fawcett Society has completed an important report that addresses the mental health issues of women with disabilities during this pandemic. As chair of the all-party group on disability, I am particularly concerned that the report found anxiety and isolation in more than 50% of respondents. Will the Secretary of State increase funding to mental health providers, with a view to helping disabled people to access the specialist support that they so crucially need?
Matt Hancock
The hon. Lady asks an important question. We have been increasing funding to mental health services, which are an incredibly important part of the response. Our mental health services, certainly across England, the area for which I am responsible, have risen admirably to the extraordinary challenge presented by coronavirus and I pay tribute to their work.
Eating Disorders Awareness Week
Lisa Cameron Excerpts(4 years, 1 month ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the right hon. Member for Knowsley (Sir George Howarth) for introducing the debate, particularly in Eating Disorders Awareness Week, on such an important issue that is often overlooked because it is hidden. He was fastidious in detailing so many of the crucial aspects of eating disorders and how our popular culture impacts on so many. I think it will go on to affect more young people as it grows under the social media stresses and pressures put on them.
I was thinking back to when I first started to think about appearances, which was probably when I was in my mid-teens, but my daughter, aged 11, is already looking on Instagram and so aware of how she looks and how many friends she has on social media. Those are not what I would call actual friendships, but these days it is all about social perception, and the pressures and stresses we put on young people through social media, which remains largely unregulated, are astronomical. We are creating a mental health catastrophe that is coming down the line for our young people. It will impact on men, who are not immune, but it impacts significantly on young women. I see that in young children of primary school age: my daughter and her friends very much relate to pictures of one another online and how they look. A societal image of perfectionism is being created that is very unhealthy for people’s mental health.
Eating Disorders Awareness Week is running this month, raising awareness of a disorder that, as has been said, affects 1.25 million people across the UK. When I worked as a psychologist in mental health services, I was aware how even then it was not a key focus in our training. Mental health professionals could benefit from much more in-depth training in eating disorders. When I was at Glasgow University, we benefited from the psychologist who came to train us having a specialist interest in the area. He is long retired and I do not know if anyone has taken his place, but training was very much dependent on individuals who had developed specialist expertise coming and lending that expertise, because those in training may not meet or have clinical experience of treating people with eating disorders unless they go on to do a specialist placement. Many of the professionals we are bringing through across the United Kingdom will not necessarily feel that they have sufficient expertise to treat eating disorders. We need to address that, particularly because, as has been said, it is not the kind of difficulty where people often come forward and say, “I have an eating disorder.” Clinicians, trying to form a picture on presentation of someone who might come with a diagnosis of depression or trauma, may notice a larger clinical picture not in the referral, but they require that expertise to pick up those symptoms early on. We know that earlier intervention creates a much better outcome for those with these conditions.
The other important issue I want to bring up is the Dump the Scales campaign, which I looked at while other hon. Members were talking. There may be more obvious signs of weight loss in individuals who present with anorexia, but those with bulimia are often bingeing and then purging, so there may not be noticeable weight loss. Such disorders can become extremely chronic before anyone picks up the symptoms. Certainly, one symptom of the disorders is denial and attributing difficulties elsewhere.
Dump the Scales is important, because my understanding is that BMI has to be at a certain level for a referral. We need to move on from that in clinical practice and look much more widely. I have just looked up the criteria in ICD-10 and, while they may have moved on, there are a number of symptoms and BMI is one of them. That needs to be considered, because, as I said, the person is not likely to come with a presentation of eating disorders in the first place and then, if some of the clinical symptoms are so stark that they cannot be referred on to appropriate services so quickly, that creates another barrier to getting the treatment they so desperately need.
Family support is another matter that we often overlook but need to focus on. We really need to get family members on board in order to have holistic treatment, particularly for young people’s mental health. It would be helpful to know more about what is being done in relation to family systems therapy and family therapy.
I was trained in the cognitive behavioural therapy model when I was practising, but it was very much a formulation-based model. I do not think eight sessions of CBT would necessarily be effective for people who have a long-standing chronic illness or perhaps other underlying issues such as trauma that need to be resolved. We need a flexible system to ensure that a person’s care pathway is at the level of service they need for the chronicity of their difficulties.
It has not passed me by that it is International Women’s Day this week, so it is apt to have this debate on eating disorders awareness, which an issue that is likely to affect so many young people—overwhelmingly women, but also men—who face this social pressure.
I will finish with a few things that the Scottish Government are trying to do. This is an area where we should share best practice and have much collaboration across the UK, and I would like to see that and be part of it. It is excellent for the way forward that an all-party parliamentary group has been reconstituted.
Last year, the Scottish Government created an online peer support tool specifically for this issue to allow young people to pair with a trained volunteer, who had themselves recovered from an eating disorder. That is important because peer-to-peer support can be extremely helpful, particularly for young people. At certain stages in life we may speak to our parents more or less readily, depending upon our stage of development, and for adolescents, among whom a higher percentage of eating disorders initially develop, peer-to-peer support will provide an excellent starting point for treatment.
The website caredscotland.co.uk is an information platform for parents and carers. We must ensure that parents and carers, who are, most often, going to be the ones who pick up the initial signs, have awareness, as well as the support they need. It is vital that parents and carers have that support because dealing with an eating disorder can take an enormous emotional toll upon an entire family. We need to look at people’s mental health in a holistic manner.
We need to do much more, right across the United Kingdom, in relation to access to treatment for those who have eating disorders. We have come some way, but we need to raise more awareness at different levels within the system. GP training has been mentioned. We also need a public awareness campaign, because often peers or families pick up the initial symptoms, and medical training for psychiatrists and those working in mental health. From my own training, I do not think those professionals have the level of training necessary to treat people in primary mental health care, which is often where an eating disorder might be picked up initially before it is referred on to secondary community mental health teams.
Jim Shannon
I am thinking about the dangers of social media and how it affects children and young people. Could the dangers of social media be made clear at an early stage, perhaps at school? The perfect body, clothes, hair and everything become things everyone wants, whereas the reality of getting them is quite different. For instance, in some photographs, models’ six packs or their weight are actually changed digitally. Social media has a lot to answer for.
Dr Cameron
The hon. Gentleman is entirely correct. Social media often creates a false world that none of us can ever live up to. That is why I welcome the Government’s work on social media, which is looking at potential regulation and other issues in relation to the impact on mental health.
This is an excellent pivotal debate, but it is not the finishing point. It is most definitely the starting point for taking these issues forward on a cross-party basis. I look forward to working with everyone who has an interest in this field, to support progress for those who have eating disorders across the United Kingdom.
Ms Dorries
That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.
Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.
We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]
That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.
To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.
The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.
In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.
Dr Cameron
I thank the Minister for making that point. I think that there should very much be a formulation-driven treatment plan whereby all the issues that the person presents with are taken on board, and different aspects may require different parts of treatment. I do not think that often happens currently, particularly where people present to primary care services and perhaps do not get the specialist services that they need, but I hope the work that is being done will streamline that for the majority of people in the future.
Ms Dorries
I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.
The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.
Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.
I think that those are all the points that were raised and that I need to answer.
Medicines and Medical Devices Bill
Lisa Cameron ExcerptsMonday 2nd March 2020
(4 years, 1 month ago)
Commons ChamberRead Full debate Medicines and Medical Devices Act 2021 View all Medicines and Medical Devices Act 2021 Debates Read Hansard Text Read Debate Ministerial Extracts
Dr Whitford
I thank the hon. Gentleman for that point. When we are trying to collaborate and get a group of 28 countries—indeed, 31 countries, because the European economic area is involved—to all agree to such enormous changes, with legal ramifications for their drug and device producers, and so on, it takes time, but in the end, I think it will be worth it. Of course, I would have liked it earlier. Having been involved in breast cancer trials, I know that the clinical trials directive was clunky and bureaucratic, but it is being changed.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I thank my hon. Friend for answering the extremely important points that have been raised. Does she agree that it is also extremely important that those with rare diseases still have access to the clinical trials that can perhaps only take place in the EU, because they need to have so many participants? The UK on its own might struggle to have those clinical trials for rare diseases.
Dr Whitford
That is an excellent point, which I will come on to shortly, and I absolutely agree with my hon. Friend.
The Bill puts attractiveness as a place to do trials and supply medicines almost on a par with safety and drug availability. What exactly does that mean? The shadow Health Secretary was right to seek a definition of that phrase. Is it about cutting red tape? If so, I would point out that one man’s red tape is another man’s life and limb. The Association of the British Pharmaceutical Industry says that the industry does not want divergence or lower standards, or standards that change all the time. Alignment with the EMA and the FDA in America keeps costs down, reduces delays and keeps bureaucracy down. The industry here will have to match EU standards for the bulk of its production and will not be keen on doing small-batch production for the UK only if that has a totally different set of standards.
It is important that the new measures on falsified and counterfeit medicines be taken. The unique identifier number, including barcode scanning, is important, as are tamper-proof containers. There is a whole market out there in counterfeit drugs and it endangers patient safety, which is vital in all of this. As part of that, we will have to negotiate data sharing with the EU and the EMA to enable pharmacovigilance on a bigger scale and make it possible to recognise much earlier patterns of side effects and complications.
How will the Government provide the extra funding and support to the MHRA, which is to take on an extensive area of extra work? How will it combine that with delivering quicker assessments and licensing so as to encourage companies to launch their devices or other drugs in the UK? As has been referred to, there is a need to replace the clinical trials directive, which in the original version was indeed very bureaucratic. As a clinical trialist within breast cancer, I found it to be often quite off-putting. The new clinical trials regulations create an EU-wide portal—a single point of digital registration of trials and collaboration on design, recruitment, data, entry and analysis. Unfortunately, UK-only regulations will not replace that when it finally goes live in 2022.
International collaboration is critical to research, and the European research network is the biggest in the world—bigger than China and bigger than the US. As mentioned by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and the hon. Member for Bolton West, that collaboration is vital for rare diseases, where the number of patients in any one country is low. That is why we have made so much progress in rare diseases, childhood diseases and childhood cancers in the past decade or so—because of funding from the EMA and collaboration on an extensive Europe-wide basis. As regards cancer, my own specialty, half of all UK cancer trials are international, and 28% of Cancer Research UK trials involve at least one other EU state. The BEACON trial for recurrent neuroblastoma involves 10 countries. It was designed in the UK, but the principal investigator is in Spain. Some of the original funding came from the UK, but the drug comes from Switzerland. Ten countries are contributing to trying to find hope for children and families suffering from this horrible disease, for which we are struggling to find a cure. There were 4,800 UK-EU trials between 2014 and 2016. How will the Government maintain that sort of collaboration and involvement?
Part 3 of the Bill relates to medical devices, and I totally agree it is not before time. The EU has also moved to bring in regulations regarding medical devices. It is important to apply similar rules to devices as are applied to drugs. Until now, it has been far too lax. As was mentioned, manufacturers pay for assessments, and I would suggest the same apply to digital health apps. At the moment, the companies that design them assess them themselves. We need instead a neutral and independent system of ensuring that they are safe. Just because something is AI or digital does not mean it will give patients good advice.
Registered clinical trials of devices should report all findings. It is far too common, where there are negative findings or findings of no advantage, that they are not published and that therefore in essence the information is hidden. As we have heard, there should be no tabletop licensing of devices whereby a device is simply migrated from one form to another without being retrialled. This was exactly the problem with vaginal mesh, where in essence the end operation, compared to the original operation in the trials, was unrecognisable. The Cumberlege review should give us food for thought and help us focus on safety and not market expediency. It is also important that there is a system to report complications to the MHRA, like the yellow card system with drugs, so that problems are spotted sooner. Again, across a bigger population that is likely to be quicker.
Implants should also have a unique identifier number that can be scanned as a barcode to the patient’s electronic records, to the hospital episode system and to any registers. A register will be data that is just sitting there and which can be interrogated if someone needs to recall patients with certain implants because of a problem. Following the scandal around PIP implants, which did not have medical grade silicon in them, I remember having to wade through the case sheets of patients who had had breast reconstruction. It was not an implant we had ever used in our hospital, but we had to be 100% certain that no patient treated in the plastics unit in Glasgow had had the implants either. It is critical that we avoid such chaos in the future, and if a register has an expert steering committee, it can become a registry, a dynamic beast that can monitor practice and bring knowledge back to medical practitioners, researchers and so on. One of the earliest and biggest examples is the national joint registry.
The Bill includes provisions to extend low-risk drug prescribing to other healthcare professionals. We all recognise the changes in the workforce that have already happened and which are coming in the future. There are processes for assessing competency and certifying that someone—an advanced nurse practitioner, for example—can prescribe in their own right. The Royal College of Surgeons and the Royal College of Physicians have raised the issue of physician associates and surgical care practitioners. They feel that if prescription powers are to be given to such individuals it is critical that they are registered and regulated, but while these new professions are developing they are not registered or regulated. If this is the future of the NHS workforce across the UK, it has to be dealt with—they need to be registered practitioners.
Social Care
Lisa Cameron Excerpts(4 years, 2 months ago)
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Martyn Day (Linlithgow and East Falkirk) (SNP)
It is a pleasure to take part in today’s debate on social care. As we know, social care covers all forms of personal and practical help for children, young people and adults who need extra support. It covers services such as care homes and other types of help, including supporting unpaid carers.
The Conservative manifesto contains one expensive pledge on the future financing of social care, saying that
“nobody needing care should be forced to sell their home to pay for it.”
It seems to me that the Conservatives have a large hole in their manifesto costing, which would imply additional tax increases, more borrowing or public spending cuts elsewhere. It remains to be seen what comes to pass.
Social care is a wide-ranging topic and in Scotland it is of course devolved. We are proud of what we have achieved in Scotland and what we continue to achieve using our devolved powers. All four UK national health services face many of the same challenges of increasing demand, workforce shortages and tight finances, but the NHS in England has of course faced almost a decade of unprecedented austerity. In Scotland we do some things differently from the rest of the UK. For example, the Scottish Government spend 43% more per head on social care. We are the only country in the UK with free personal care, which we recently extended to all under-65s who need it, and that now benefits nearly 80,000 people, including more than 10,000 self-funders in care homes. It gives people peace of mind and security. That is not without cost and challenges, but it helps to reduce delayed discharges and it reduces emergency admissions, and on balance it is estimated to be cost-effective. The Scottish experience would certainly support the call for the UK Government to bring forward plans for free personal care elsewhere in the UK.
Despite UK Government cuts to the Scottish budget, in Scotland we are continuing to invest in social care and integration, and the integration is one of the most significant reforms since the creation of the NHS. Of course the devolved Administrations do not operate in isolation and policy decisions from Westminster continue to have an impact on social care. Brexit, for example, is going to be potentially catastrophic for the Scottish social care sector, and while we remain within the Union it will impact upon us.
The Expert Advisory Group on Migration and Population report warns of the damage that ending free movement will inflict on social care in Scotland, saying
“the overall reduction in EU immigration would be especially challenging for those sectors most reliant on lower-paid, non UK workers, including occupations such as”—
you’ve guessed it—
“social care”.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
My hon. Friend is making an excellent speech. Does he agree that we must realise and champion the great skills that social care workers have? It is not about earnings in this case; it is about our gratitude to them for looking after some of the most vulnerable people in society, and that should be recognised by Government.
Martyn Day
I agree wholeheartedly with my hon. Friend: we cannot put a price on the care that people get.
To return to the expert advisory group report, it said that in the social care example, reduced migration could adversely affect female family members who themselves are most likely to exit the labour market to cover gaps in care provision that would have otherwise been delivered by a migrant workforce.
In the last Parliament my hon. Friend the Member for Argyll and Bute (Brendan O'Hara) lobbied the UK Government to evaluate the effects of EU withdrawal on the health and social care sectors through his private Member’s Bill. No fewer than 102 third sector organisations, trade unions and charities have publicly supported the measures in the Bill, and more recently the UK Government have made it clear that they will not commit to aligning with EU standards or accept the jurisdiction of the European Court of Justice. Addressing the Scottish Parliament’s Culture, Tourism, Europe and External Affairs Committee, Cabinet Secretary for the constitution, Michael Russell, said:
“this would result in new barriers to trade and exports, a fall in national income compared to EU membership and damage to social care and the NHS.”
The SNP Scottish Government will be introducing a new continuity Bill to the Scottish Parliament soon, which would make it easier to align with future EU standards in such areas as the environment and human rights.
Children’s Mental Health Week
Lisa Cameron Excerpts(4 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
It is a pleasure to respond to the excellent speech by the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), and I thank her for securing this important debate. I also thank the Members who made interventions, to which I will respond, with your permission, Mr Deputy Speaker.
I do not recognise some of the scenarios that the hon. Lady described. I have not read her article, but if she would like to give me a hard copy, I would be delighted to read it. She is obviously passionate about this subject. I have been in the House all morning, but I have had time to glance at the Children’s Society report that was published today. I was delighted to see that the Children’s Society highlights that the Government have made huge efforts to tackle mental health stigma through tireless work with schools and the Every Mind Matters campaign, which has reached 1.3 million people countrywide.
I am pleased that this debate is occurring during Children’s Mental Health Week. Today is also Time to Talk Day, which encourages everyone to be more open about their mental health in an effort to end mental health discrimination. It is going to be difficult to achieve parity of esteem between mental and physical health until we can completely eradicate the discrimination associated with mental health.
Our most recent data shows that one in eight five to 19-year-olds has a mental disorder. When it comes to young women and girls, the data is even more striking. Young women and girls are more at risk of self-harm, with about three times as many young women and girls aged 10 to 19 self-harming compared with men. The suicide rate for women and girls between the ages of 10 and 24 is at its highest on record, and it has nearly doubled since 2012. So I am with the hon. Lady on her concern about mental health and young people, and I am particularly concerned about the mental health of young women.
Those figures are heartbreaking. However, as the recent Children’s Commissioner’s report highlights, there have been major improvements to children and young people’s mental health care in recent years. I think it is important that we accept that. We need to get to that place so we can look forward to where we take these improvements.
I would like to mention Claire Murdoch, who is the clinical lead in NHS England responsible for the delivery of mental health programmes, as highlighted in the long-term plan. Claire described this to me yesterday as a bath that had been left empty for a very long time which suddenly had had the funding taps switched on—but we cannot fill the bath from empty to full immediately. The bath is filling, and it is filling with the £2.3 billion that this Government have committed to mental health. Just to put that into perspective, that is over half of the entire prisons estate budget. That is how serious our commitment is to addressing parity of esteem and mental health, particularly the mental health of children and young people. We will continue to drive forward this progress to ensure that every child can access the high-quality mental health care that they deserve.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I refer the House to my entry in the Register of Members’ Financial Interests.
Funding for mental health has increased right across the United Kingdom from when I first started in the field. However, we are really trying to raise awareness at the same time, and the more we raise awareness, the more we increase the demand. Increasing awareness and demand is a good thing, but we need many more psychologists to be working in the field alongside the psychiatrists to meet the demand.
Ms Dorries
One of our announcements has been to launch the trailblazer schemes, which we are hoping to have in 25% of schools by 2024. I do understand the problem in the hon. Lady’s area. I recently spoke to a headmaster at a school in Birmingham, and he told me that a third of the pupils in his school were receiving pastoral care or mental healthcare, and the reason was that a third of his children came from chaotic homes where either one or both parents were addicted to gambling, drugs or alcohol. As a consequence of having a third of the school roll in this situation, the school had serious problems with the children in the school.
So in some areas the challenges are very difficult. The hon. Lady said that we cannot just throw money at this, but the money has to fund the services—that is where it has to start, and then the workforce have to come.
The trailblazer schemes are doing incredibly well. I went to see one in Hounslow recently. We have committed to having 50,000 more nurses and are trying to train more mental health nurses, and we are having great success in getting people through universities and through the right courses and into schools. The school I visited in Hounslow, where the mental health workers were working for the children, was incredible to see. I spoke to a large group of the children who are receiving mental health support during the day, and they told me that they are being taught coping strategies. One young boy, whose name I will not mention, said to me that he suffers from anxiety—he gets anxious—and they have put an app on his phone so he has his time to be anxious and panic. His app time is at six o’clock, and he will go on to his phone and use his app.
There are so many aspects to the care being provided in school. There is early intervention, spotting mental health problems as they begin very early on. They could spot eating disorders almost as soon as they were arising in young girls. There are also issues such as anxiety and depression, and others that may not wholly be mental health-related but where the presentation of the problem was a mental health issue.
We are hoping to have 25% of schools across the UK covered by 2024, but, as I said, the bath was empty, so when we turn the tap it cannot fill straight away. The work has started. The people are being trained; they are being rolled out in schools right now, as we speak. I can say that early intervention, having seen it at work myself, is working. That was reassuring, because 18 months ago there were none of those teams in schools; there was no early intervention in any school anywhere. So the fact that we are watching these teams roll out into schools is incredibly reassuring.
On eating disorders—I will work my way through my speech, just to make sure I cover every aspect—more young people are getting the treatment they need. There has been a significant improvement in treating times in NHS care. An extra £30 million is being invested every year into children’s eating disorder services and there are 70 new or expanded community-based teams covering the whole country. Nationally, we are on track to meet the target of 95% of children and young people with an eating disorder accessing treatment, with a one-week referral for urgent cases and four weeks for routine cases.
I went to an eating disorder unit a week last Friday and met some of the young women there. It was fantastic to see the work being done. Once the young women go in, they have to stay in for quite some time. I am not sure that many people realise that an eating disorder is the deadliest mental health condition. One in four young women die from their eating disorder. It is the only mental health condition where the person suffering from it is scared of getting better. It therefore presents an incredible challenge to the mental health professionals who are working with those young girls. I saw the new eating disorder unit up and running, the work it was doing to turn the young women around and the investment that has gone in. The unit is managing to turn those young women around in a shorter time; it is just fantastic to see.
While recognising that we are still filling the bath and that there is more to do, what I really want to do is celebrate—I do not think that the hon. Lady will blame me for doing so—the good work being done by NHS professionals, including doctors, mental health nurses and those coming out of universities, to work on our trailblazer schemes in schools with young people. I want to celebrate their achievements. I am also very pleased that, after years of under-investment, NHS funding for children and young people’s mental health service is now rising and will continue to rise as we work towards the goals set out in the long-term plan. Funding for mental health services will grow faster overall in the NHS budget, in real terms worth at least £2.3 billion. The funding for children will grow faster than the funding for mental health care, which will grow faster than the overall NHS budget. This transformative investment will mean that by 2023-24 an extra—this is an important figure—345,000 children and young people from nought to 25 will receive mental health support every year.
Of course, some children will unfortunately experience a mental health crisis and will need rapid mental health support. I, like others across the House, am pleased with the strong focus on crisis care in the NHS long-term plan, which sets out investment of about £250 million in crisis care. I am not sure who mentioned A&E and hospitals; maybe it was the hon. Lady. We now have, in almost all A&Es across the country—I think it is 97%—a mental health liaison worker.[Official Report, 12 February 2020, Vol. 671, c. 9MC.] When somebody—a child or an adult—presents at A&E with a mental health condition, they are now seen by an A&E mental health liaison officer.
I am aware, however, that there is also a need to provide more support in the community, and to encourage early intervention and prevention. In fact, most of the £2.3 billion that has been allocated to mental health is for community services. Tim Kendall, NHS England’s national clinical director for mental health, says that no mental health service is ever better provided in a hospital than it can be provided in a community, except for the most serious cases. That is why we are delivering a new school and college-based service to help children and young people, staffed by a new workforce, through our children and young people’s Green Paper on mental health. It is about encouraging partnership working between services, and bringing together health and education to provide early intervention mental health support for children.
Dr Cameron
The Minister is being extremely generous in giving way. There is a lot of good work being done, as she has underlined, but one of the gaps—this is often raised by Members across the House—is autism diagnosis and intervention at an early stage, so that children get the support they need with the least detriment to their learning, development and education. She may not be able to respond today, but perhaps she could let me know about that at some point.
Ms Dorries
It would not be appropriate for me to respond to that because autism is not in my brief as a Minister. That comes under the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), but I will make sure that the hon. Member gets a response to that question.
To turn to the children and young people’s mental health Green Paper, every school will be encouraged to have a senior lead for mental health as well as access to mental health support teams, which are the trailblazer schemes.