Medicines and Medical Devices Bill
Lisa Cameron ExcerptsMonday 2nd March 2020
(4 years, 2 months 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, 3 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.
The National Health Service
Lisa Cameron Excerpts(4 years, 6 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is an absolute privilege to speak in this debate on the Queen’s Speech and the NHS. I basically committed most of my adult life to working in the NHS. I heard the poignant speeches from the hon. Members for Dudley South (Mike Wood) and for North Tyneside (Mary Glindon) regarding their very personal experiences. That goes to show that the NHS is part of us all—it is part of our families—and therefore we owe it a debt of gratitude. We owe it everything we have in terms of supporting it going forward.
I am pleased that, as the debate has progressed, it has seemed much more cross-party and consensual. When I worked in the NHS, I would have said that having it pelted about like a political football was no good. It might seem like something we can all banter about in this place, but for staff working in the NHS and watching it, it is very serious, and they want it and the issues to be taken seriously. I am therefore pleased that, as the debate has continued, we seem to be coming together on many issues and to be able to take them forward consensually.
I pay particular tribute to the staff who work in the NHS and in social care because that role is largely undervalued in today’s society. However, it is absolutely crucial. To be honest, the NHS just does not function without the integration with social care that we are trying to achieve. Fifteen minutes of care is not enough. This needs to be appropriately funded. I know that from personal experience, as a carer for my own grandmother. We had to bring her to live with us because we felt that the social care system left her feeling quite lonely; she had only certain episodes of care each day. She needed mental stimulation as well as practical physical care. So I hope the Government will consider those issues and make sure that we look at social care in a holistic way and that we look at people’s mental health and loneliness alongside their physical health needs, because 15 minutes of care, as it has been tagged, is certainly not enough.
I am delighted that mental health is a key focus. Had I been elected 20 years ago, when I started my career in the NHS—beyond that now, if I am honest—that would have been a closed door. We have come quite a long way in terms of mental health. There is a long way still to go but I am pleased that it has been prioritised. I ask that there is investment for child and adolescent mental health services. As awareness of the need grows, young people are coming forward, but they need to be seen and treated very quickly.
In particular, I want to ask the Minister about training in autism diagnosis for staff in CAMHS. It is not about providing new staff to CAMHS; it is about providing training for existing staff, so that there is no postcode lottery anywhere in the NHS. For a family with a young child reaching those developmental milestones or losing one or two developmental milestones, waiting for a diagnosis and adequate support is far too long a time to wait.
I pay tribute to the Thalidomide Campaign, which had its 60th anniversary event at Speaker’s House just last week. My constituent, Jerry Cleary, has battled for years for justice. I ask the Minister to consider meeting me, members of the campaign and Members who have constituents who are affected because they told me last week that they feel like the forgotten campaign—the forgotten tragedy—and that really cannot happen in today’s society.
Like other Members, I would like to mention medicinal cannabis. I have a tragic case in my constituency. Lisa Quarrell has a young son, Cole Thomson, who has now been prescribed medicinal cannabis, but they have to pay for this prescription at great cost. It will not be prescribed in the UK, so they are having to travel back and forward. Can she be included in the medical trials going forward? She came down to meet the Secretary of State and he promised that she would be included, yet she has not been. She needs to know what the outcome is and we really urge him to see this through.
I thank everyone who has taken part in the debate in a consensual way. I hope that we continue to build on that because, as I have said, the NHS is there for us all in our time of need. We must be there for the NHS.
Social Care Funding
Lisa Cameron Excerpts(4 years, 7 months ago)
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Sir Vince Cable
That is a helpful and humane suggestion, and if we approach this whole question in terms of its practicality, rather than with abstract ideology, we might make some headway. What my hon. Friend suggests seems an eminently sensible way to start that process.
The last and most difficult issue is the one in which successive Governments have got hopelessly bogged down: the so-called catastrophe risk for the small number of people who are caught with prolonged expenses as a result of residential care. When I was in government the Dilnot report attempted to address that issue, but I think we have moved beyond that now. This is a classic problem of insurance, and it is now recognised in a way that it was not before—I think the current Prime Minister said this publicly—that the private insurance market cannot, and will not, deal with this problem. If there is to be insurance it must be social insurance, and large numbers of people will have to make a contribution to prevent the burden falling on a small number of unfortunates who contract long-term conditions, with all the costs involved.
That could be done in a variety of ways. One idea is a supplement to national insurance. Another idea from 10 years ago, which I had no problem with, is that if we are to solve the problem of people losing their inheritance, everyone who pays inheritance tax should pay a small supplement. That struck me as a good social insurance principle. Whether or not that formula was right, we have now got to a point of accepting that this is a social insurance problem, and there are different mechanisms for dealing with it. If we are reasonably grown up politically, we should find a way of closing that gap.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The right hon. Gentleman is making a fantastic speech on what we will all agree—Brexit aside—is the issue of the day. I visited Parkinson’s UK in East Kilbride, and Parkinson’s sufferers are particularly affected by social care catastrophe burdens because theirs is a degenerative condition that can start in their 50s, or even earlier, and go on for the rest of their lifespan. Does the right hon. Gentleman think the Government should look at conditions that particularly affect people and start by focusing on those as a priority, as the hon. Member for Totnes (Dr Wollaston), the Chair of the Health and Social Care Committee, said?
Sir Vince Cable
The hon. Lady is quite right. We are talking about a variety of conditions. I listed some, and Parkinson’s is clearly one. With Parkinson’s, it is difficult to separate the health and the social element, which is one of the problems with a lot of these conditions and why the current distinction is so arbitrary and unsatisfactory.
Perhaps I could finish with a quotation from Her Majesty the Queen, although it does not relate to her need for social care. Two and a half years ago she made a speech in which she said:
“My Ministers will work to improve social care and will bring forward proposals for consultation.”—[Official Report, House of Lords, 21 June 2017; Vol. 783, c. 6.]
That was two and a half years ago, and the basic question is: where are they?
Artificial Intelligence in Healthcare
Lisa Cameron Excerpts(4 years, 8 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is an absolute pleasure to serve under your chairmanship, Mr Paisley—I believe it is the first time I have done so in Westminster Hall, which is particularly pleasing to me. I thank everyone who has taken part in this excellent debate, and I particularly thank the hon. Member for Crawley (Henry Smith) for securing it. I think the one thing on which we can have cross-party agreement is that the more debates we have in which Brexit is not the focus, the better. I am sure we could all go through the Lobbies to agree on that.
This is such an important debate, and I think the public and many of ourselves as MPs are just beginning to catch up with how important it is, which is why I am particularly pleased that the hon. Member for Crawley secured it. He linked technology, the NHS and artificial intelligence in such a detailed speech, and he chairs an important all-party parliamentary group. We can see that technological advances are saving lives on the frontline, which is tremendously important to people right across the United Kingdom. That is why we cannot over-focus on this issue. More and more debates will be about it in so many different domains, particularly in health.
The hon. Gentleman brought up an important issue: education of the public, which will be absolutely key going forward. It is such a crucial issue for us all to consider, because it is not just about medical and healthcare professionals becoming educated, and perhaps their training changing over time to incorporate all these new techniques and procedures, and about how the world is becoming much more digitalised, with 5G and so on coming on stream; it is also about public understanding and ensuring that the public are involved in their healthcare going forward, and that they are absolutely able to engage with it.
Like the hon. Member for Strangford (Jim Shannon), I am a real technophobe. It took me over a year to try to pay for things by tapping a debit card on machines in stores. Now, I love it. I probably do not even carry any money now, but at first I was so anxious that I would be walking about and having money removed from my bank account that I avoided using it. That is one of the concerns about the technology. It is about bringing the public and those of us who, unlike my own kids, have not grown up with such technology as the norm.
We have to get people on board and ensure that, across the lifespan, people can really benefit from the digital revolution that is happening, and that people do not become more isolated and left out of society because they are left behind. That is important for their physical health—monitoring prevention and so on—and for their mental health, in terms of feeling really engaged and involved in society. We have to integrate all this with the professionals in our healthcare settings, with the public being a key focus.
As has been said, artificial intelligence will be so crucial at every step of the patient’s journey. It will include prevention—we have already heard about some of the developments. There is some amazing work being done at Queen’s University Belfast on early prevention, detection of ovarian cancer—my goodness, how life-saving will that be?—and early interventions, not just for physical health, but for mental health. I am very keen for us to look at how we can engage more with AI and digital technology, perhaps in relation to depression, anxiety and how patients can monitor their mood, and at how technological advances can promote what we want to do: achieve parity of esteem for mental health services and physical health services. There is also treatment and recovery. It will be about prevention, early intervention, treatment and recovery, and the technology will be crucial at every step of the way.
I was pleased to hear the hon. Member for Cambridge (Daniel Zeichner) talk about developing standards, because everything in healthcare is about developing standards, best practice and guidelines, and that is what fosters the public’s faith in the work that we do. Our NHS is so loved right across the United Kingdom. When private companies bring their expertise in research and technology into such a beloved institution as the NHS, it is extremely important that the public have a sense of those companies’ remit and the sensitive nature of the data, that protection and security issues are addressed, and that standards are of the utmost importance for maintaining that.
The hon. Member for North East Derbyshire (Lee Rowley), too, spoke of the importance of security and international collaboration and research. Again, we have to think about other countries and how they manage data. We take part in lots of clinical trials—I am going to mention the EU, then move on to talk about, more broadly, the situation internationally. We have to look at developing standards commensurate with those of other countries, and we must at least know the limitations of the collaboration that can be undertaken when it involves our NHS and is about our patients’ data. He also mentioned his personal family circumstances and how important the advances have been for his own family and their healthcare. It is always very poignant to have that personal experience to bring to debates, and to speak about the impact that has made.
I looked around a few times just as I sat down, and I thought, “Why is the chair behind me empty, and where is the hon. Member for Strangford?” Then I turned round again a third time, and there he was. He never fails to take part in as many debates as possible in the House of Commons, and to ensure that his constituents are so well supported and their issues addressed at every step of the way. I am pleased that he recently learned to text, because it sounds like he is similar to me in being trepidatious about technology. Both our examples show why we have to educate the public and try to ensure that we all become up to speed with the technology. I mentioned the wonderful facilities at Queen’s University Belfast, where I was going to go and study before deciding to stay at Glasgow University; when I was training as a clinical psychologist, I had also applied to Queen’s. I could have gone to Queen’s if I had not gone to Glasgow, so I have always had a soft spot for it. I am delighted that its research is formative and will make such a difference.
From my experience of working in health, I know that computer programs managing data are very important, but the systems do not link up. For instance, health boards pay millions of pounds for systems that work for child services and for adult services, but the data cannot be transferred between the two. Children become adults, so how do we merge the data across their lifespan? Will the Minister look at that issue? For most people, transferring data seems commonsensical, but it is not happening in practice. Aligning it better would save a lot of money; we should not have to change systems that have already cost the taxpayer millions of pounds.
I was pleased to secure a debate on smart cities just before the recess, in which we talked about 5G. Driverless technology will enable ambulances to get to incidents much quicker when we have 5G technology and the next industrial revolution—this technological revolution—happens. I would be interested to hear from the Minister how 5G fits in with the issues we are debating and the advances that are being made. Where does she see the future lying?
I have spoken about this issue with some international delegations, particularly from Japan and China. We talked about the fact that technology and artificial intelligence have had an impact on social care. Robotics is being used in care homes—for example, robots can remind patients to take their medication. I would be interested to know a bit more about how we are linking to our international partners. We must collaborate safely in a way that enables patients in social care and the NHS to benefit from technological advances.
We have talked about how important this technology will be for surgical procedures. That was described very well. I agree wholeheartedly that there must be a partnership between robotic techniques and skilled clinicians. That is what the public wants, and that will always be the safeguard as we take these issues forward.
On the issue of prevention, smartphones and smart watches, technology has had a massive impact on reducing missed appointments in the NHS. Sending patients a text to remind them to come to appointments saves money and clinicians’ valuable appointment time.
Social media must be responsible when it comes to health. Through its technological advances, it is already playing a huge part, but young people in particular often get inappropriate information from websites that are not properly regulated. The large companies must take much more ownership of those issues. I have discussed these issues with Facebook and Twitter recently. There are sites that tell people how to develop an eating disorder or harm themselves. We must look at regulating them further. Will the Minister address their impact on mental health? Will she think about not just mental health treatments that we can develop through technology, but about how we ensure appropriate regulation is in place for sites that are not managed by our NHS or professionals and are causing harm to the public?
I am pleased to say that Scotland is to have its own £15.8 million AI health research centre based at the University of Glasgow. It will be a genuine collaboration between NHS research and other industries. We are keen to ensure that all partners are involved and that we can generate the very best practice in technology and healthcare.
Body Image and Mental Health
Lisa Cameron Excerpts(4 years, 9 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is a privilege to speak in this debate. Indeed, it is always a privilege to speak in debates about mental health, and, having worked as a psychologist prior to coming into Parliament, I always think my timing has been good, because 10 or 15 years ago we would not have been speaking about mental health, and the doors to any conversation about it would have been firmly closed.
I am always grateful that these issues are prioritised by Government. The Minister has been doing a fantastic job in this regard, working cross-party, and she has all our support. I thank her for the work that she has done and I too hope she continues in her position; if I could send in a recommendation or something, I would be very happy to do so.
Andrew Griffiths (Burton) (Con)
I am not sure a recommendation from the Opposition Benches will help.
Dr Cameron
Indeed.
Body image is a very important issue, and it is an interesting one as well, because it is coming more to the fore through social media and through society in current times, when there is this striving for perfection. As we heard, in the past that might have been about looking through glossy magazines, but now it is all about how glamourous we can look on Facebook or Twitter, how many friends we have, and how many people want to befriend us because of the way we look—because they think that equates with our being some kind of fantastic person, when of course it often does not. And sometimes the most glamorous of people can also be the most shallow, I have to say.
Society is encouraging stereotypes that place great stresses on our young people today, and that has an adverse impact on their mental health. Social media companies must look at this in much more detail in terms of regulation, as we have heard. I have been very pleased to contribute to the work done through the Department, which is looking at issues of social media abuse and the impact of social media on young people’s development and mental health and how they relate to the world. It is almost as if we have become an artificial world rather than engaging with each other in our day-to-day lives just as we are, with all our diverse shapes and sizes being the norm.
Andrew Griffiths
The hon. Lady is raising some very important points, and I think we all recognise that young people are under more stress and pressure than ever before, particularly through social media. Does she agree that schools have a key role to play in trying to provide support for young people? I am sure that, like me, she welcomes the new Trailblazer programme that the Government have offered, but does she agree that if we can ensure that young people feel able to ask for support and help in the classroom—in the school environment—we will have a better opportunity to tackle these issues at the very start and help those young people before the problem gets worse?
Dr Cameron
Yes, those points are well made. We must do much more in the classroom to help young people grapple with social media issues and pressures, and to develop positive mental health and coping strategies so they can do that. We also have to help parents, like me and others here today, to understand social media; often children are far ahead of us and it can be very difficult for us to regulate what is happening online and make sure it is safe and secure.
I also commend the work of the all-party group on mentoring and the Diana Award. I recently went to a number of their events, one up in Scotland at Holyrood and one at Westminster just a few weeks ago. They are doing fantastic work to help young people who are being bullied in school and to provide peer mentors, because often, as we know, young people listen to other young people rather than parents or teachers. The work they are doing is going a long way in giving young people skills to understand how to challenge bullying, and to promote good mental health and to understand that it is very important that we support each other in society, rather than doing each other down. I commend them for their work.
I am chair of the all-party parliamentary group for textiles and fashion, which is undertaking an inquiry into inclusion in the industry. We have started our inquiry sessions, which have been extremely interesting. We have heard that although the industry is trying to become more diverse and to promote more diversity among its models and in the work that it prints, there are still many challenges and barriers for young disabled people and plus-size people in becoming models or getting into the industry at any level. We hope that the inquiry will highlight and raise awareness of the issues and ensure that the industry lives up to our expectations that it should be inclusive and diverse, just as the United Kingdom is.
The all-party parliamentary group on psychology recently conducted a research study that showed that although the number of abusive posts to politicians was almost equal across the genders, the content was quite different. Whereas male politicians were criticised for their position on a policy, female politicians were much more often criticised for the way they looked, held to account for not wearing the right things in Parliament—according to whoever thought they were the fashion guru—or trying to do them down based on their personality or personal appearance. That shows the stereotypes that must be overcome and the challenges in feeling confident in politics. We must support everyone to make sure we have a diverse Parliament moving forward.
When I highlighted this debate online today, my constituents asked me not to forget to mention how men are affected in terms of body image. That is such a good point. We often speak about the impact on women, and I have been doing that in much of my speech. They said, “Please don’t fail to mention how men are impacted because this is increasingly an issue in society, and the same stereotypes apply: having to be really buff, no matter what your day entails or if you are running about trying to juggle lots of different things. Always having time to go to the gym and to look fabulous and have all the best clothes etc.—these things also put pressure on young men.” I attended a very sad but poignant tribute at the weekend to my constituent Ryan Coleman, who sadly took his own life. We really must not underestimate the pressures on young men’s mental health nowadays in society. It is incumbent on Governments across the United Kingdom to ensure that young men as well as young women feel able to come forward, be referred and take up services; there is often much more stigma for young men in accessing services and acknowledging some of these issues.
We have spoken about cosmetic procedures. I do not have too much detail to speak about on that, but I am aware that there is not much regulation of such procedures and it is important that we get on top of that. As the Minister and the shadow Minister mentioned, when things go wrong, it is not just like having to go back to the hairdressers and getting a different colour put on. Cosmetic procedures can have a permanent impact on people, or affect them for a very long time, so regulation in this market is important. Other markets may be diminishing, but this market is growing exponentially so we definitely need to have regulation in place.
When I worked with people who have eating disorders, we knew from the research that body image was a core part of the issue that people struggled with. It is not just about weight; it is about cognition. It is about how people think about themselves. I worked with young people who were growing thinner by the day and had anorexia nervosa but felt that they were fat. When they looked at themselves in the mirror, they saw themselves as overweight and strove to lose more and more weight. When an eating disorder develops over time, we know that cognition becomes affected. That is why it is very important that people can be referred to local services. I know how difficult that can be.
When I was doing some work in mental health primary care, the problems in referring someone to tertiary care and eating disorder services were almost insurmountable. People had to go through the community mental health team. Weight comes into it again. They might not be quite at the threshold, but everyone in the family and the clinicians knows that the person is developing an eating disorder. We must have services that accept people, and a clear clinical pathway. Otherwise, by the time people arrive at the service that they need, their condition has deteriorated so much that they may need to be admitted to hospital.
We also need to ensure that we can treat people with eating disorders as close to home as possible. They often need cognitive behaviour therapy or family therapy, and families really need to be involved in that care. If the care is taking place 20 or 30 miles away from where the person lives, it is so difficult for families who are grappling with all the other demands on their time to be as involved as they really want to be.
Ahead of Mental Health Awareness Week this year, the Scottish Government announced a new advisory group on body image and young people’s mental health. It is important to have that group up and working; to be thinking about the issues that test young people today. We need to be ahead of the curve. The Scottish Government also recently announced a package of funds for social media advice for young people. We are very aware of the impact of social media. When we are looking through magazines, we can put them down and go off and do something else, but social media is constant. I see this with young people, including my own children: as soon as their phone rings—ding ding—they have to look. Social media is almost like an addiction. I am sure that the companies love that because people are becoming so reliant on it. We need to make sure that our young people have varied lifestyles; that they get out and about in the fresh air, as my mum used to say. I am repeating my mother now. I hope she is listening. I never thought that I would get to that stage, but there you are, I am. It is important for health.
I am extremely pleased to have spoken in this debate. I am pleased that it has been given time in the main Chamber, where it should be, that we are prioritising mental health and that we are discussing the important issue of body image.
Children and Mental Health Services
Lisa Cameron Excerpts(4 years, 10 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank the hon. Member for Burton (Andrew Griffiths) for securing this extraordinary debate, in which there have been many contributions from both sides of the House and many interventions, which shows that the issue is a high priority in our constituencies. It is important that the subject was brought to this Chamber. His speech was detailed, extensive and passionate. I congratulate him on being an assiduous representative of his constituents.
We have heard about the main issues; I will not go through them all again but point some out. Workforce is obviously a problem, as are training, access to services, prevention, treatment, trauma and eating disorders. We have also heard about social media and how technology can be helpful in signposting people, but can also undermine mental health in young people, so appropriate safeguards must be put in place.
We have heard constituency cases from across the United Kingdom. The Office for National Statistics shows that the highest rate of suicide is in north-east England and Wales, but all Governments across the United Kingdom need to make tackling suicide a priority. I thank the Minister, who has been working hard on it and has made significant progress. The problem is, however, that we had such a long way to go that we are not yet where we want or need to be.
I thank the British Psychological Society and the Paediatric Psychology Network UK for sending me their updates and views. They pointed out the problem with access to child and adolescent mental health services and that the services continue to be run on medical models, so if a young person presents with suicidal thoughts or behaviours, unless they have a concomitant mental disorder such as depression or an eating disorder, they do not always gain access to the treatment part of CAMHS. That is wrong, because not every young person will be medically classified as having a disorder, but may need access to coping skills, treatments, counselling and perhaps family therapy. They may have social issues, rather than a condition that requires a medical diagnosis, but they still need access to crisis care to prevent suicide.
That has been brought home to me in the last couple of weeks, as we have suffered our own tragedy in East Kilbride. Ryan Coleman, a young man with his whole life ahead of him, took his own life. This weekend, I am going to a tribute event to mark his life and what he had accomplished in such a short space of time, and to support his family and friends. Families should not have to go through such tragedies, however, and Parliament must do more.
I thank the Trust Jack Foundation in Stonehouse, which has set up young people’s services to bridge the gap and make sure that something happens between a referral to CAMHS and being seen by CAMHS. It gives young people access to support from other young people who experience mental health issues and to support-based activities and therapies. Again, that came out of a personal tragedy—the loss of Jack—which his mother, a wonderful woman, has turned into a positive thing for other children across the area. I cannot thank her enough.
Transitions are important; we need to focus on the transition from child to adult mental health services, and services in colleges and universities. Will the Minister think about the children who have lost a parent serving in the armed forces, and update me on that? A couple of weeks ago, I went to an event with the armed forces parliamentary scheme where I found out that there is a lot of work going on in the US to support young people who lose a parent in service, but there is no much support, treatment and access to services in the UK. Obviously, children who lose a parent serving in the armed forces also lose their home and support network. They have to make dramatic adjustments, and for young people, that is a critical time.
Governments across the United Kingdom are trying their best to improve services, but we have a very long way to go. I want to help everybody in Westminster and the other Governments to achieve the progress we need.
Listeria: Contaminated Sandwiches
Lisa Cameron Excerpts(4 years, 10 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
What is happening in hospitals? Surely we should be role-modelling fresh and healthy produce? Giving people packaged produce, including sandwiches, to eat gives them the wrong message about health and rehabilitation. Surely we should be role-modelling correct behavioural choices at every opportunity when somebody goes into hospital? Will the Secretary of State speak to the Government’s behavioural insights team to consider taking that forward? In my experience, kitchens in hospitals do exist. If he looks deeply into the issue, he will find that staff and visitors often have restaurants in hospitals. However, fresh food from those restaurants is not always made available to patients. We need to tackle and stop that inequality, particularly when patients are fragile, frail and elderly.
Matt Hancock
I will happily look into the last point for the hon. Lady. She is absolutely right that a hospital should be a role model of fresh and healthy food, because after all, what is a hospital but a place to try to make us all healthy?
Medical Cannabis under Prescription
Lisa Cameron Excerpts(4 years, 11 months ago)
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Jeff Smith
The right hon. Gentleman is absolutely right. That points to the issue about where we get the product from. The problems, allegedly linked to increased episodes of psychosis, are from high-THC street cannabis, which is not what we mean when we talk about medical cannabis products. As I said, there are lots of different types of cannabis products. They are very often CBD-based, but when they contain THC—the psychoactive element—it is a much, much smaller amount than in street cannabis. It is like comparing apples and pears. He makes a really important point.
We need to look at how we can learn from evidence in countries such as the Netherlands, Germany and Canada, as well as countries that have successfully introduced medical cannabis regimes, such as Australia and Denmark. What work are the Government doing to learn from the experience of those jurisdictions? There are currently at least 138 medical cannabis trials worldwide. We need to take into account that global evidence.
I would like to ask the Minister a number of questions. Why can clinicians make individual decisions on certain conditions but not others? For example, clinicians can make individual decisions on a case-by-case basis on Crohn’s disease, which my constituent’s grandson suffers from, but not on some other conditions.
We need a scoping exercise to look at how we can enable patients to get this medicine now. There are estimated to be something like 3 million cannabis users in the UK, with around 1 million of those using it for medical purposes. Those figures may be high but, whichever figures we look at, there are hundreds of thousands of people using cannabis to alleviate pain or help with a medical condition. At the moment, they get their product from the street—from the illegal trade. That is not good for them or for society. That is the key point. People are already using cannabis for medical reasons and getting it from illegal suppliers.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I thank the hon. Gentleman for giving way; he is making an excellent speech. On that point, I had a visit to my constituency surgery from one of our veterans, who had incurred an injury during his service. He was in chronic pain and felt that cannabis alleviated that, but he did not wish to buy it; he wished it to be prescribed and for Ministers to look at the research and studies, to ensure that veterans who need that assistance can have it.
Jeff Smith
That is not an unusual case. There are lots of people who want to use medical cannabis and do not want to buy it from the street or go to Holland to import cannabis products, and they are frustrated.
I will wind up, because I have been speaking for longer than I intended. On the funding issue, there are cases of clinicians being willing to prescribe but being blocked by trusts or CCGs. What is the Minister’s understanding of how many cases there are where funding is the issue, rather than prescription? Even where clinicians are willing to prescribe and there is new thinking, CCGs do not have budget lines for some of these products, so the reluctance is understandable. I am interested to know whether the Minister has any information on that.
It might cost more for the NHS to supply more medical cannabis prescriptions, but we have to compare that with the reduction in other costs. The estimate is that opioid costs would be 25% lower, and there would be fewer hospital admissions. Professor Mike Barnes said in his evidence to the Select Committee that we could probably introduce medical cannabis in this country on the NHS at no net cost, when we take into account the reduced costs elsewhere.
Our system is clearly too restrictive. It is not working. We need creative thinking and flexibility from the Government, and we need them to look at the different types of evidence from around the world. There are people in this country who, if they were living in Holland, Australia or Canada, would be able to get on with their lives, get their cannabis products legally and not have the worries of the campaigners in our Gallery today about them or their children and relatives having to go through chronic pain or the episodes of epilepsy that we have seen in young patients over the last year.
We all want to make some progress and are desperately frustrated that we are not able to get anywhere. I refer the Minister to the evidence given by Professor Mike Barnes. We need to look at other types of evidence to inform ourselves of a way to deliver the products that our patients need into their hands.
John Howell (Henley) (Con)
I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi) on securing this timely debate. Let me start by picking up on something that my hon. Friend the Member for Reigate (Crispin Blunt) mentioned: all we are talking about is medicinal cannabis. We are not talking about making cannabis available for general recreational use. I am sure that there are Members of the House who would have an opinion on that, and we could have a full debate on it, but we are talking only about use for medicinal purposes. The wording of the motion is very important. When I read it, I saw that it stressed the practicalities of getting cannabis medicines prescribed. It is not about the general issue—we had the debate on that and the Home Secretary reached his decision—but about the practicality of getting some sort of result.
I realise that this is not easy for the medical profession and that the Government have initiated a review of the barriers to clinically appropriate prescribing. That is a very important review to undertake. I am aware that the National Institute for Health Research is going to participate in the review, which is a positive step, and I will set out what I think are a couple of the barriers that prevent prescribing
What we are really waiting for is some NICE guidelines. I understand that they are coming, but they need to be brought along pretty quickly. We cannot wait for them forever, nor can the children who are suffering.
Dr Cameron
The hon. Gentleman is making an excellent point and an excellent speech, which relates to the practicalities for children in my constituency such as Cole Thomson. His mother, Lisa Quarrell, has been trying to get medicinal cannabis for him for some time. Not only does she have to battle his absolutely debilitating epileptic illness, which gives him multiple seizures every day, and to see the deterioration each day in his condition, but she has to battle the medical system, battle with financial costs and battle the Government as they take one step forward and two steps back, giving hope and then taking it away. It is too much and too traumatic for any family in that situation to cope with.
John Howell
I thank the hon. Lady for her excellent intervention, and I agree with much of what she said.
One of the main barriers that I see is the simple question of who is allowed to prescribe. The General Medical Council holds a list—a specialist register—of specialist doctors who are allowed to prescribe. Why do we have a specialist list, and why can only those on that list prescribe? Is it because people are nervous about their careers or other things? Why do we limit the number of doctors who can prescribe in this way? I have read claims that something like 110 patients have been prescribed the medicine, but from what has been said in this debate, I understand that only one has received it.