Mental Health Act: CQC Report

Lisa Cameron Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

I thank my hon. Friend for that comment. He has highlighted both the reason why we tasked the CQC with conducting annual inspections and an instance in which, having been given a conclusion and a set of recommendations, we have delivered, and we will do the same in respect of this report.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The report makes clear the need for a major shift in focus that will place patients at the centre of their care. What is required is a human rights approach in which the least restrictive option is adhered to. Detention must be the last resort.

A key issue is that patients feel invisible in the present system. Will the Minister go to the frontline? Will she visit the hospitals, speak to the staff about resourcing, and speak to the patients and the carers who are in, and have been through, the system? Will she hold the focus groups that are so badly needed with patients and carers to ensure that the system is overhauled and their voices are heard?

[Jackie Doyle-Price]

The ethos that the hon. Lady has outlined is very much the one that is being proposed by Sir Simon Wessely, which is why he is organising round tables, but I assure her that I am visiting services at the frontline as well. At the core of the point that she has made is the issue of a rights-centred approach for mental health patients, and that too is at the centre of Sir Simon’s inquiry. Patients need to be empowered to ensure that they receive the right treatment. Central to that is the whole issue of consent, which is something that very much concerns me, and not just in the context of mental health. We may be able to take the lessons from Sir Simon Wessely’s review and apply them elsewhere in the NHS.

Cancer Strategy

Lisa Cameron Excerpts

Thursday 22nd February 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I beg to move,

That this House has considered the Cancer Strategy.

Thank you, Madam Deputy Speaker, for your guidance. I will try to behave much better timewise in this debate, which it is an honour and a privilege to introduce. I pay tribute to the Backbench Business Committee for enabling the debate, to the all-party parliamentary group on cancer for its timely and extremely important report and, in particular, to the hon. Member for Basildon and Billericay (Mr Baron), who could not be with us today but deserves our thanks for the extraordinary amount of work he has done on this issue.

We in the House are all on the same side against cancer and in our ambition to achieve world-class cancer outcomes. My speech will address—briefly, according to your instructions, Madam Deputy Speaker—the recommendations of the all-party group’s recent report, “Progress of the England Cancer Strategy”. The report received more than 80 contributions from charities and bodies and truly reflects the passion in the sector, but it is also a cry for help, progress and a positive way forward. My speech will address the report’s four main areas of concern: workforce strategy, data, transparency and funding. It is open to colleagues to raise all aspects of cancer care and treatment, but, on behalf of the all-party group and the hon. Gentleman, I will stick to the recommendations in the report.

The report considers progress as we reach the halfway point of the NHS cancer strategy 2015-20 and is the result of an inquiry that the all-party group held last summer and autumn. The inquiry was formally launched at a summer reception last July and the number of written submissions was far larger than anticipated, showing the dedication of those working in the field. Many submissions came from cancer alliances and others on the frontline of the services being provided and identified many pressures and challenges. The evidence from frontline services in particular seemed to amount to a call for help. In its report, the all-party group concluded that although progress had been made since the launch of the strategy, the NHS

“will struggle to achieve the objectives set out in the Cancer Strategy unless corrective action is immediately taken.”

To this end, the all-party group has listed recommendations, a copy of which will shortly be sent to all MPs. The lack of workforce planning emerged as a key concern. The cancer workforce is constantly recognised as the biggest barrier to implementing our strategy. We are all pleased that Health Education England published its report into the cancer workforce in December 2017, but it was originally promised for December 2016. According to written evidence from Breast Cancer Now, the workforce is the greatest challenge in delivering the cancer strategy. The all-party group also heard that transformation funding is being withheld from cancer alliances because of their performance against the 62-day waiting-time target—a new conditionality of funding that emerged only after the bidding process had closed.

[Mr Jim Cunningham (Coventry South) (Lab)]

I appreciate the hon. Lady acknowledging the cancer organisations, such as Macmillan, which often rely on subscriptions. Does she agree—I am sure she does—that the public should be encouraged to give more subscriptions where possible?

[Dr Cameron]

Absolutely. The hon. Gentleman makes an excellent point. These agencies are working on the frontline with people and families at their most vulnerable and deserve all our encouragement, praise and, of course, funding.

In addition to setting out how cancer alliances are to be funded and supported for the duration of the strategy and into the future, the all-party group strongly recommends that the 62-day waiting-time target be immediately decoupled from any release of funding to the alliances. The previously mentioned issues prevent progress in improving cancer care and treatment, which is not our collective vision. The all-party group also heard that improving transparency in priorities and accountability would help to support the delivery of the strategy. At the moment, a lack of clarity and lines of communication are delaying its implementation. Publishing a detailed progress update on each of the strategy’s 96 recommendations would be a positive step forward.

It is generally accepted that the 62-day waiting-time target has been treated as a higher priority among clinical commissioning groups and cancer alliance leaders than survival or stage at diagnosis, as shown by the linkage between funding and performance against the measure. Decoupling funding from process and target performance in favour of a greater focus on outcomes would strongly be in the interests of patients, not least because, if outcomes are good and survival rates increasing, processes will also be functioning efficiently and correctly.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

The 62-day target has not been met since 2014, so the issue has been around for a while. Does the hon. Lady agree that more funding is needed if the target is to be met as soon as possible?

[Dr Cameron]

I absolutely agree with the hon. Gentleman. It is essential that the target be met and that resources be put in to ensure that it is.

The all-party group also found that access to detailed and timely data is critical for the strategy’s success, particularly in relation to data for rare and less common cancers. Strong concerns were also raised about how future data protection regulations might affect surveys, such as the cancer patient experience survey. The value of the cancer patient experience survey should be emphasised, along with outcomes from patients. We must hear from those who are experiencing services; they know how to improve things. In addition, the ageing UK population cannot be left out of the conversation. The cancer patient experience survey suggests that older people are less likely to have access to a clinical nurse specialist. Additionally, older patients are less likely to know the full extent of their illness. Age discrimination must come to an end, especially in cancer care.

The all-party group recommends that the NHS and Public Health England’s data team work to produce more timely cancer data and make them publicly available. It advocates that the Government ensure that the cancer patient experience survey and other such surveys can continue in a way that allows patient experience to be considered on a par with clinical effectiveness, rather than leaving patients without sufficient information regarding their cancer and care.

Furthermore, for specific cancers such as breast cancer, there are key priorities for delivery in the cancer strategy. It must ensure that data are collected for people living with incurable secondary cancer; that everyone with secondary breast cancer has a specialist nurse with the right skills and expertise; and that everyone has access to the right support after finishing treatment for primary cancer, so that they are able to live well after breast cancer. We should not ignore the fact that the strategy has had positive effects. In the last year, 16 cancer alliances and three vanguards have been established, and £200 million has been made available to them for earlier diagnosis and post-diagnosis support. In addition, 23 NHS trusts have now received new and upgraded radiotherapy machines. However, as the report makes clear, much more work still needs to be done.

In the few minutes that I have left, I want to speak a bit more about less survivable cancers. The Less Survivable Cancers Taskforce was in touch with me prior to today’s debate. It is made up of Pancreatic Cancer UK, the British Liver Trust, the Brain Tumour Charity and Action Against Heartburn, covering oesophageal cancer, and Core, covering all digestive diseases. The staggering 55% gap in morbidity is absolutely unacceptable. Much, much more must be done. Recently, I lost a very dear uncle to pancreatic cancer. As a family going through that experience, we know that we need much more research and much more specialist understanding. We need investment in those areas—it is absolutely crucial. I want to ensure that other families have a better chance of an improved survival rate, and I pay tribute to my own uncle for his courage in coping with that condition right to the end.

Hospice care is also absolutely essential. We must ensure that families and patients have dignity at the end of life. That is imperative. I have watched far too many family members die in hospital beds, surrounded by other patients with the curtain screens drawn, to know that that is not dignified and that where possible, we must improve services and access to hospice care.

I pay tribute to the Teenage Cancer Trust—we often think of cancer as an illness that affects older people, but young people are also diagnosed with cancer—which does fantastic work. Vanessa Todd in my constituency is an absolute advocate for the Teenage Cancer Trust. Although GPs may not expect a young person to come with such symptoms, which are perhaps not easily identifiable, it is something that we can increase awareness of to make sure that diagnosis is very quick and timely for young people to improve their prognosis.

I thank everybody and, again, I thank the all-party group. It has been a privilege to open the debate for the hon. Member for Basildon and Billericay, who leads the group on these issues so well.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Before I call the next speaker, I say to hon. Members that I am going to try to continue my experiment of seeing whether people will self-regulate and behave in a decent, honourable fashion. That means taking eight to nine minutes, and not 13, 14 or 15 minutes. I trust the well experienced Mr David Tredinnick to do so first.

--- Later in debate ---

[Dr Cameron]

Today’s debate has been so profound and amazing, with so many personal contributions. I have been absolutely astounded by the breadth and depth of knowledge across the House and the absolute dedication to the cancer strategy right across these Benches. I am assured that we will work together, taking things forward very positively and making a difference.

It is important that we have discussed the fact that cancer cuts across the lifespan and recognise the serious issues for young people and their experience of cancer. We also looked at not just the physical aspects, but the mental health aspects and the support that is required. We talked about the fact that treatment has to be holistic and evidence-based.

I wish to commend the valuable contributions from charities and our NHS staff. To be honest, their support is invaluable because they are on the frontline. I also wish to mention the very personal contribution of the hon. Member for Lincoln (Karen Lee). She made such an amazing speech today. I am sure that, given her experience, she will go on to support and assist so many people, and I am delighted that she is a cancer ambassador. I am sure that many people will benefit from that in the future. Once again, I thank her and everybody here today, and I look forward to working with them on this issue.

Question put and agreed to.

Resolved,

That this House has considered the cancer strategy.

Hospital Car Parking Charges

Lisa Cameron Excerpts

Thursday 1st February 2018 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an honour to speak in this debate, and indeed in any debate in which the NHS is at the heart of what is being discussed. I particularly thank the right hon. Member for Harlow (Robert Halfon) for bringing the debate to the House. As has been discussed, the matter is extremely important to patients, charities, emergency workers, volunteers, carers and NHS staff, so it is a credit to him that he secured this debate. He set out his case most eloquently and comprehensively.

The SNP Scottish Government scrapped hospital car parking charges approximately 10 years ago in all car parks that are owned by the NHS. I urge the UK Government to follow both this principle and policy.

As an NHS employee for more than 20 years, I must declare an interest. I was part of the campaign, all those many years ago, as a Unite rep, to scrap NHS parking charges. I was so pleased when we succeeded, because that has made a great difference to many people, and has saved some of the most vulnerable who are already facing so many financial difficulties from spending money on parking.

[Robert Halfon]

The hon. Lady has been very generous in giving way, and I thank her for her kind remarks. Given that, for the most part, hospital parking charges have been scrapped in Scotland, she must have heard about how the problem of people perhaps misusing the car parks to go shopping or whatever was dealt with.

[Dr Cameron]

Indeed. Where there is a will there is a way. It can happen; it can be done. Basically, it is a matter of prioritisation and making things happen. That issue can be raised with the Minister today.

Hospital car parking charges hit the most vulnerable people in our society: disabled people; those who are chronically and even terminally ill; families caring for terminally ill children; and those who require repeat appointments and lengthy hospital stays. Before the change in Scotland, I heard about families and couples who had had their cars impounded because their partner was giving birth in the maternity unit and things did not go quite to time, as happens so often in these cases, and they were unable to feed their meter. At a time of utmost importance for the family, that is one of the last things that we would want to have on our mind.

NHS staff, particularly those on community-based shifts, are also penalised. They often have no choice but to use their cars to travel from the hospital to make community visits, so they cannot travel by public transport to their hospital base. There is something fundamentally wrong with charging our valued NHS staff to get to their work of saving lives when their pay has already been affected for so many years by caps.

The SNP is clear that the founding principle of the NHS is services that are free for everyone—services that are not out for profit. We have heard today from hon. Members that it is sometimes cheaper to park in town centres than to park at hospitals. That just cannot be right. By 2015, getting rid of hospital car parking charges had saved patients and staff in Scotland more than £25 million. Parking charges are basically a tax on NHS treatment, and that cannot be allowed to go on. As chair of the all-party group for disability, I am particularly concerned that people with disabilities, who we know are more likely to experience poverty, are being doubly financially penalised if they require medical treatment, as in England they have to pay for hospital parking—should they have retained their Motability vehicles of course.

The right hon. Member for Harlow is right that there are pragmatic ways to address the issue. The things that are said to prevent change from coming about can be overcome. He discussed tokens and other pragmatic ideas that can be put in place and that can work. We have made this work—we made it a success—so it can happen. With the will, there is the way.

I will take a brief moment to extend the issue from hospital parking charges by addressing parking for NHS staff in health centres. I believe that all health centres in my constituency have free parking, aside from the new Hunter Community Health Centre multi-storey car park. I have been in a somewhat intransigent negotiation with NHS Lanarkshire for more than a year, as only a limited amount of permit parking has been made available for staff. This has unfortunately meant that some staff—often those in lower pay bands, such as admin staff—face extortionate weekly charges for getting to work. That is unprincipled and unfair. Why should we penalise only staff who work in a particular health centre?

On Fridays, I have taken to monitoring the free spaces in the car park. I can assure the House that it is half empty every single Friday, which is usually an extremely busy day for car parks elsewhere, so there are enough spaces for the staff. I once again urge NHS Lanarkshire’s chief executive, Calum Campbell, to reverse this decision and ensure that permits for staff, as requested, are restored and that this principled step is taken. I will be writing to him after the debate, which I am sure he will look forward to, as he always does. I will let him know that he has been mentioned in the House of Commons once again.

I thank hon. Members from all parties who have taken part in this debate: the hon. Members for Great Grimsby (Melanie Onn), for Telford (Lucy Allan), for Kingston upon Hull West and Hessle (Emma Hardy), for Colne Valley (Thelma Walker), for Slough (Mr Dhesi), for Batley and Spen (Tracy Brabin) and for Enfield, Southgate (Bambos Charalambous); the hon. Member for Cleethorpes (Martin Vickers), who raised an important point about people in rural areas being badly affected; the right hon. Member for Hemel Hempstead (Sir Mike Penning), who made an extremely pertinent point about volunteer drivers; and the hon. Member for Heywood and Middleton (Liz McInnes), who worked for the NHS as fellow Unite rep in my time, and who has done great work for the NHS.

Everyone who has spoken has urged the Government to act. We do not need any superficial rhetoric, but we do need action. I ask the Minister and the Government to act by putting NHS patients, staff, carers, relatives, volunteers, emergency workers and those who care about the NHS first. We are all requesting change. This request must be taken forward, and I trust that the Minister will do so.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for his work and thinking on this through the Public Accounts Committee, and he is absolutely right. I am more than happy to talk to him about this, but we actually have it as a priority to make sure that when NHS land is disposed of, NHS workers get the first opportunity to buy or rent the houses that are built.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

There are still not enough staff trained in autism diagnosis across the NHS. Would the Secretary of State consider training a specialist in each community child and adolescent mental health service right across the country to ensure that there is no longer a postcode lottery?

[Mr Hunt]

I would always listen to the hon. Lady on those matters, because she has huge professional experience. I do not think we do well enough for families with autism, and we are looking at what we can do better, but I have a lot of sympathy for the case the hon. Lady is making.

Stroke Services

Lisa Cameron Excerpts

Tuesday 5th December 2017 Commons Chamber

[Sir David Amess]

My hon. Friend is spot on in her analysis. I know that the Minister will take the points that she has made to heart and consider how we can improve the present situation.

Consensus forecasts predict that 150 trained people are required to run a fully functioning 24/7 national service. Mr Guyler says that training in stroke intervention is not readily available, that not enough hospitals can afford 24/7 availability and that there are not enough expert neuroradiologists to interpret CT scans. He says that there are turf wars between neurologists, cardiologists, neurosurgeons, radiologists, vascular surgeons and neuro- radiologists on who can and will perform interventional stroke treatment in the future. I do not think it is for politicians to get involved in those turf wars. The medical staff need to sort out between themselves who will lead in these matters. Apparently, there are also turf wars between university and district general hospitals on who should perform the procedure.

Mr Guyler also highlighted the fact that we have the expertise to develop this treatment significantly. The UK has one of only five training simulators in Europe—we should be proud of that—which is based at Anglia Ruskin University.

What are the Government doing to encourage more areas to reconfigure acute stroke services? We do need a new national stroke plan. I was at the launch of the original plan at St James’s Palace many years ago, but it is now time for a new one.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The hon. Gentleman is making an excellent speech on stroke services, which are invaluable right across the United Kingdom. I refer the House to my entry in the Register of Members’ Financial Interests. Does the hon. Gentleman agree that it is important that people who suffer strokes also have access to psychological services? Many people experience depression when adjusting post stroke, and it is important that counselling is available to support them through that.

[Sir David Amess]

The hon. Lady, with her considerable expertise in this area, is right to bring that particular matter to the attention of the House. We certainly need more provision of the women and men who give that sort of support.

A significant part of a new national stroke plan should be the development of 24/7 access to mechanical thrombectomy for all United Kingdom citizens, no matter where they live. Southend has already shown itself to be both safe and effective. It exceeds the recommended audit standards, its improvement in patient outcome is similar to international trials and, despite a severely ill patient collective, its results exceed the British Association of Stroke Physicians’ quality benchmarks. I want all my constituents to have 24/7 access to the best possible stroke treatment, so I urge the Government to find a way of effectively introducing mechanical thrombectomy to all parts of the United Kingdom. What is the Government’s assessment of the national stroke strategy, and will the Minister update the House on progress with its replacement?

I am not criticising the Government’s provision in any sense but, as with all these things, we could and should do more. We could do better. It is frustrating that a wonderful technique is available but is not available to everyone. Perhaps we can find a few more resources now because that should result in a saving in the long run. Finally, does the Minister agree that this wonderful facility at Southend Hospital is a further good reason for Southend to be declared a city?

Autism Community: Mental Health and Suicide

Lisa Cameron Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I beg to move,

That this House has considered the support available for autistic people experiencing mental health problems; calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework; and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathway.

I thank everyone across the House, no matter what side of the Chamber they sit on, who supported the application for this important debate to the Backbench Business Committee. It is truly a cross-party endeavour to raise the profile of this issue, awareness of mental health issues within the autism community, difficulties about access to services, the importance of funding adequate support, and the progress we all must make across the UK for this population.

I thank the many autism charities, mental health charities and research groups that have reached out to me over the past few weeks.

[Paula Sherriff (Dewsbury) (Lab)]

Will the hon. Lady join me in thanking the Whole Autism Family, a charity run by Anne-Marie and Martin Kilgallon in my constituency, who have two autistic boys and who do so much to support other families, who can find it difficult to access medical and other healthcare?

[Dr Cameron]

I thank the hon. Lady for her important words. The bedrock of much of the work undertaken across the UK is such small charities, often run by those who have personal experience and know what works and what needs to be done.

The level of interest in the debate shows the importance of the issue. It is important to so many across the UK, including charities such as those already mentioned. Many charities have contacted me with important recommendations, including Autistica, the National Autistic Society, the Royal College of Psychiatrists and the British Psychological Society.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the hon. Lady on securing this debate. Will she join me in congratulating women’s organisations in Coventry that are very much involved in mental health issues among younger people and older people in particular? What help can they get? Often, women act as carers and the Government should do something about that and give proper grants to those organisations.

[Dr Cameron]

That is an extremely important point. We must bear it in mind that for young people with autistic spectrum disorder, there is often a family-systemic approach, with carers are at the forefront of providing support, and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to the hon. Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Chesham and Amersham (Mrs Gillan), who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

[Mr Kevan Jones (North Durham) (Lab)]

I accept the point that the hon. Lady is making, but I have to tell her that waiting lists in Durham are still two years long.

[Dr Cameron]

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

[Kevin Brennan (Cardiff West) (Lab)]

Does the hon. Lady agree that mental health issues for adults with autism can arise out of the way in which they are treated when they encounter the criminal justice system? The behaviours that sometimes accompany autism can be misinterpreted by people in the criminal justice system. Does she agree that we need not only to get the health provision right but to ensure that the people working in the criminal justice system understand about autism and take it into account when they meet adults with the condition?

[Dr Cameron]

Yes, I wholeheartedly agree with that point. I have personal clinical experience of that through working across a variety of secure hospitals and prisons in my practice with the NHS. People with autistic spectrum disorder often find themselves caught up in the criminal justice system, which has little awareness of their needs or of the support that they require. When they get caught up in the system, it is difficult for them to move on and rehabilitate because the provision simply is not there.

[Mr Jim Cunningham]

Following on from the point made by my hon. Friend the Member for Cardiff West (Kevin Brennan), there is an argument that the police lack the training to handle some of these young people because they do not understand the nature of their mental illness. Does the hon. Lady agree that something needs to be done to provide the police with the necessary training?

[Dr Cameron]

I agree. Our police are on the frontline and they deserve the utmost respect for the work they do, but yes, it is correct to say that they require further training and also further support. There requires to be a clearer pathway when people exhibit challenging behaviours in the community, from the point at which the police are put into contact with them right through to the provision of adequate support in the health system, without their being caught up in the criminal justice system in between.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The hon. Lady will be aware that the societal body that is most likely to come into contact with someone who is likely to take their own life is the police. The police, and particularly the British Transport police, are doing critical work in assessing how staff can be trained to identify potential suicides and to take action to take people back at a time of crisis in their life in order to prevent them from taking forward a suicide. We should not knock the police too much. They are doing fantastic work in this area.

[Dr Cameron]

I wholeheartedly agree. As I said, the police are on the frontline. They face the crux of the matter when it comes to matters of life or death. They are doing their very best with the training and resources that they have, but there requires to be a clearer pathway so that people who are at that crisis stage can access health services—and probably crisis health services—and so that the police have somewhere to ensure that the clinical needs of those people are met. It is unfair for our police to have to take care of people’s clinical needs when that is not what their training provides for.

In 2016, an academic study in Sweden, which was published in the British Journal of Psychiatry, found that people with autistic spectrum disorder were nine times more likely to die by suicide than the rest of the population. The latest research indicates that people with autistic spectrum disorder account for a harrowing proportion of suicides in the UK. There is a 16-year gap in life expectancy between people with autistic spectrum disorder and the general population. To put it all very bluntly, people with autistic spectrum disorder are 28 times more likely to consider suicide than the average population —28 times. The statistics make one thing abundantly clear: what we are doing now to support people with autistic spectrum disorder is not working and is not enough. Research shows that almost seven in 10 people with autistic spectrum disorder experience mental health issues, including anxiety and depression. Services must be in place to ensure that people are cared for holistically. We have to meet all their clinical needs, which may mean their autism or their learning difficulties, but they will almost certainly have mental health issues. Quite frankly, we do not have services in place today that take account of the complexity of such needs.

What types of things are going wrong for people at the frontline? It is difficult for people with autistic spectrum disorder to access mental health support through the usual routes. For most of us, that might mean going to our GP as a first point of contact for primary care for mental health problems, but a GP practice is a daunting, unfamiliar place for people with autistic spectrum disorder. One young man wrote to me and described a recent trip, saying that it was

“quite hard for me to access the GP anyway. The whole environment is difficult. It’s noisy, there’s often children, it’s very hot. There’s also a loud beep when they call the next person that I find really quite painful. When you’re feeling emotionally poorly that becomes almost impossible.”

GP surgeries make reasonable adjustments for wheelchair users every day—simple changes that make the life of the patient easier—so the same policies should be implemented for people with autistic spectrum disorder. We need training to raise GP awareness. Access needs to be easier. We need to ensure that GPs know who on their register has a diagnosis of autistic spectrum disorder.

If an autistic person bypasses the GP and goes straight to mental health services, they may face unprecedented waiting times or they may simply be refused treatment. When individuals do attend services, they may find that they are discharged without any follow-up. At the Health Committee last week, we heard how a young autistic boy was turned away by child and adolescent mental health services four times, despite feeling suicidal, because he had not yet attempted to take his own life. Things have hit crisis point, and we need to ensure that we engage in prevention. Someone attempting to take their own life should not be the point at which they receive treatment. We need early intervention to pinpoint the symptoms of difficulty and where we should be aiming the treatment.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank the hon. Lady for securing this very important debate. We both sit on the Health Committee, and during the inquiry into suicide prevention we heard that the point at which someone is most likely to take their own life is, tragically, when they are discharged from in-patient care. The Committee’s recommendation was that everyone should be contacted within at least three days, and we are waiting for the Government to respond that. Does she agree that everything should be done to ensure that the most vulnerable, including people with autistic spectrum disorder, should be supported in that period when they are extremely vulnerable to ensure that they do not take their own life?

[Dr Cameron]

I agree. That is an extremely valid point. If people arrive at A&E for crisis intervention and are admitted for a period of time, it is important that they are discharged with some follow-up. People often return to the same circumstances that led to the difficulties in the first place, and if they do not have some support to deal with those difficult circumstances, they may be in a vulnerable situation and may try to self-harm or take their own life once again.

If a person with autistic spectrum disorder feels unable to go to the GP or to reach out to services in their local community, they might try to ring a suicide helpline. However, that can be extremely difficult in itself for a person with autistic spectrum disorder who finds communication and social interaction difficult. They might be able to verbalise only some of their difficulties, and they may then find there is no follow up from that service, either. Early access points and early intervention are crucial to preventing suicide and preventing mental health problems being exacerbated. Much more has to be done at that critical early intervention stage to ensure access to services.

If a person with autistic spectrum disorder reaches a health professional, they often find that their mental health problems are overlooked or misdiagnosed, which might be because they present an extremely complex case. They might also have concomitant learning difficulties, and they might not present the symptomatology that would usually be expected for anxiety or depression per se because their symptoms are complicated by their autistic spectrum disorder. It is extremely important that mental health practitioners have training in autistic spectrum disorder, in the types of presentation that they might need to identify and, particularly, in risk issues.

Diagnosis is still a postcode lottery. I hope to continue working with the Minister on that issue, because we need an understanding of who is appropriately trained in diagnosis of autistic spectrum disorder and what level of specialty we have in different professions. What is the workforce plan to ensure that this very great need is addressed across our society? This is so important. People with autistic spectrum disorder say they do not know where to go locally. As a member of the Select Committee on Health, I have asked services about that, and they say, “We don’t really have a map of who can diagnose and who can provide specialist intervention in a given area of NHS England.” Streamlined services would make it so much easier for people to gain that initial access.

I do not want to take up the whole debate, so I will provide a brief overview before letting others speak. Many Members want to contribute to this important debate, but I wish to touch on a few other important issues.

I request that the Minister look at what mental health therapies work specifically for people with autistic spectrum disorder who have concomitant mental health difficulties. There is no adequate research base yet, but we know it is critical—it is lifesaving—so we need to prioritise funding. Traditional mental health therapies might not work in the same way for people with autistic spectrum disorder. If one of us presented at a GP surgery, we might be offered cognitive behavioural therapy, but we do not know whether that is the best option for a person with autistic spectrum disorder, or whether some kind of adapted therapy would be more appropriate. That important work should be undertaken, and undertaken quickly, to engage people in appropriate therapies and save lives.

I have been contacted by a couple of individuals whose poignant accounts have struck me. One is an individual from my constituency who says that she has continually tried to access CAMHS for her daughter, who has been repeatedly self-harming. It has placed the family in such a stressful situation over a lengthy period that the family, including the mother and carers, now feel that their own mental health is under stress.

It is extremely important that we ensure not just that individuals can access the system but that we preserve family life, that we support carers and families, and that we do not place an additional burden on the NHS and other services. Families and parents may go on to develop their own depression and anxiety when dealing with an intractable situation because they do not know how to cope. If we do not address the problem at its root, we will multiply the problem for services across the UK.

[Mr Jim Cunningham]

I met a number of carers some months ago, and one thing that struck me was that from time to time they were extremely distressed. Some of them could not afford a holiday and they do not get very much help, to say the least,—they are not even paid as carers—so there is an effect on the mental health of the carers sometimes as well.

--- Later in debate ---

[Dr Cameron]

Yes, that is exactly the point I am making. We are exacerbating the problem for families, and they are at grave risk of having their own mental health difficulties or separations if placed under significant stresses over a period of time. Such things can be avoided if supports are put in at an early stage, and we can address the difficulties and give them the help they need in that way.

The other case that struck me this week was that of an individual who contacted me last night to say that they hoped this debate would make a difference. They had been struggling for a long time to access services for their daughter, who had been self-harming over many years and in the past few weeks had tried to throw herself on to a dual carriageway under a number of cars. She had been feeling at crisis point—breaking point—and had been feeling isolated, having a lack of peer support and of clinical help at the time of need. This individual had been discharged from CAMHS a number of times after referral for assessment. I understand that if an individual comes to a CAMHS service and does not fit a diagnosis initially, it can be difficult to think of the types of services or follow-up they need, and they may be discharged. However, that has to be looked at, because young people in this situation have grave clinical need. They might not fit a clinical or diagnostic box, but they do have clinical needs that require following up. These young individuals are falling through the gaps, and this family was concerned that their young person would literally be falling under a car and they would be losing them for good. That just cannot be something we allow to happen in today’s society. As I say, this is a crucial issue—it will be life-saving if the Minister can show the leadership that we need today.

The five year forward view for mental health recommends that NHS England should develop a referral-to-treatment pathway for people with autistic spectrum disorder. That would be a vital step, as things are too complicated; people do not know where to access services and they do not know where to go. Even the services themselves do not know the best route forward for people after they present, so this has to be streamlined and we need to see progress in this regard.

As has been mentioned, we also need to look not only at children with autistic spectrum disorder but across the lifespan, at adults. It is very important that adults who may have autistic spectrum disorder have access to a diagnosis in the first place, and that if they present with mental health issues they are able to receive the support they need. This care pathway has to straddle the lifespan, so that none of our constituents, right across the UK, fall through these gaps.

It will be important to ensure that we undertake the GP registers, which are recommended by the National Institute for Health and Care Excellence, whereby individuals with autism are highlighted to GPs on these registers so that they can signpost them to correct supports. That is an extremely important issue. Last time this issue was debated, the Minister at the time said that the Government were “open” to these suggestions about the registers, and it would be important to hear an update on that today.

The Scottish Government have launched their own Scottish strategy for autism in 2011, declaring autism a “national priority”. I concur with that, as it is a national priority. This means more than simply diagnosing autism; it means that we must think about people with autistic spectrum disorder right across our communities, and about their access to services, to community services and to shopping centres—their access to society at large. This is bigger than just health, so I would like to know how the Minister is going to liaise with other Departments to make sure that we do not leave people with autism behind and to ensure that that message is embedded in all Government policy.

I have written to the Scottish Government to ask for an update, because I have read their policy thoroughly and it is extremely good, but constituents still contact me to say that, with respect to the implementation on the ground, they are having the same difficulties accessing services and that things are not working as they should. Perhaps the Scottish, Welsh and UK Governments can work together to ensure that best practice is in place for people with autism right across the United Kingdom.

I really hope that the Minister will listen to at least some of the recommendations raised in this debate. Other Members from all parties will have extremely important accounts to give. I welcome all the accounts given and interventions made. This is a vital issue of concern, so it is important that we work together, across party lines, to ensure that people with autistic spectrum disorder and mental health problems do not fall through the gaps but have the services they deserve.

[Several hon. Members rose—]

--- Later in debate ---

[Mrs Trevelyan]

I thank the hon. Lady for her comments.

Despite the cross-party efforts of all those for whom this is a passionate policy area—for 18 years I have cared for my son, who is now a young adult with autism—there are some people who are having a miserable time in the mental health system and are not yet benefiting from improved access to core therapies and services: men and women throughout the country on the autistic spectrum. We must do better.

Across the board, a quarter of us will experience mental ill health during our lives, but within the autism community that rises to eight in 10—of those diagnosed as autistic, eight in 10 suffer from mental ill health. To those of us familiar with autism, that is sadly not a surprise. Society is designed for us neuro-typicals, as my son likes to call me—I am not sure it is meant as a compliment—so almost everything designed for us can cause stress or worry for those who are wired differently. A different perspective on the world has huge potential benefits for our society and economy, and we fail all those on the autistic spectrum to the detriment of not only the individual but society more widely.

We are failing these individuals. When I did some research for this debate—as I always do, if I can, for anything relating to this subject—I was appalled to discover the scale of suicide across the autism community. Autistica, the UK’s autism research charity, revealed international findings that autistic people without a learning disability are nine times more likely to die by suicide than the rest of the population. The charity’s research is now beginning to uncover almost identical rates in the UK as it starts to build the research database. As a parent, that is just awful to hear; but as an MP, it is a rallying cry. The exact causes are still being researched. We live in a complex environment and people are complex anyway. If we stick them in an environment that is often alien, it is not surprising that it is sometimes too hard to cope.

There are three clear ways in which our mental health services are letting our autistic citizens down now, and we have a duty to address them. First, we know that autistic people’s mental health problems are often misdiagnosed or missed completely. Despite mental health problems being the norm, there are no systematic mental health checks for autistic people. These problems can often present very differently, partly because so many become practised at masking their feelings to fit in. If someone is severely autistic, it is perhaps almost easier to identify them as sufferers, but those who are managing to live in a mainstream environment have learned some extraordinarily clever, adaptable ways to cope with our neuro-typical world and to their own very severe mental ill health. What is truly traumatic for one autistic person might not be for another, so when they do seek help, as the hon. Member for East Kilbride, Strathaven and Lesmahagow highlighted, autistic people can often find that their worries are dismissed out of hand. They are missed or misunderstood.

The NHS Five Year Forward View for mental health recommends the development of autistic-specific care pathways for mental ill health. That work, as I understand it, is supposed to begin in 2018, but we have heard nothing about it since February. Perhaps the Minister will be kind enough to update us on the project: is it still taking place; who is leading it; what is its scope; and how will autistic people be involved in helping to design it to make sure that we are not missing some very obvious things? Those things might not necessarily be obvious to those of us who are neuro-typical, but we must think in the different way that our wonderful autistic community so often does. This is a crucial opportunity to begin transforming care for autistic people, but we must get it right.

Secondly, we know that autistic people can struggle to find the support that works for them. It is assumed that what works for us neuro-typicals will also work for them. Autistic people may benefit from cognitive behavioural therapy but, as the hon. Lady who is an expert in providing such support says, being made to group work with strangers can be entirely counter-productive. We need to think about how we can adjust that support. The idea that someone who has issues with understanding, with being able to read faces, with processing information would in any way feel supported when they are in a state of deep stress shows a complete gap in understanding. The stresses and the symptomatic problems of people with autism make it more difficult for them to cope.

[Dr Cameron]

The hon. Lady is making an extremely powerful speech, as she is speaking from very personal experience, which is extremely valuable in this Chamber. I have also heard some disturbing accounts in the past few weeks of people with autistic spectrum disorder being referred to group-based therapies, which also shows a lack of awareness of symptoms, as they have issues with being able to interact socially and to communicate. That would place an individual with autistic spectrum disorder under even greater stress than if they underwent a different form of therapy.

[Mrs Trevelyan]

I absolutely agree. I work closely in my constituency with the families who are supporting their autistic children. Clearly, dealing with strangers, with the unfamiliar, and with group dynamics is possibly one of the most difficult things to ask an autistic young person—or indeed an older person—to take on.

We have for too long neglected the research into mental health therapies for our autistic community, even though that tops the list of research priorities if we ask those in that sector. I very much hope that the Government will look to support those who are doing this work. In our manifesto, we said that we

“will address the need for better treatments across the whole spectrum of mental health conditions”—

by—

“making the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.”

I support those words wholeheartedly and hope that the Minister will be encouraging and will help us to do much more.

Thirdly, let me mention NHS data gathering—this is an issue that comes up in any number of NHS-related debates, but it is critical in this one. GPs are so often the first port of call for those with mental ill health. Going to a GP can be really, really difficult for autistic people. It is an environment with unfamiliar lighting, sounds and rules that cannot be escaped. The hon. Lady’s example of a bell going off is a classic one. It is the unfamiliarity and the pitch of the unexpected sound. There is a lack of understanding by neuro-typicals about what certain pitches of sound can do to those who have hyper-sensitivities. To an autistic young boy or girl, it can be like a bomb going off. We need to consider the impact of such things on those with these heightened sensitivities, especially when they are in a strange place and already in a state of anxiety. Strip lighting in public spaces is another thing that creates enormous tension.

--- Later in debate ---

[Dr Cameron]

This has been a wonderful debate. It has been truly cross-party and collegiate, and we must work together to improve the lives of people across the autistic spectrum and the services that we provide for them. This is about lifespan, so it involves a number of services for all aspects of the lifespan. It is also about streamlining the transfer from child to adult services. This is a multi-departmental matter, and I urge the Minister to speak to other Departments to ensure that the autism strategy is embedded in all their policies. As has been said, we need more early diagnosis, awareness and support in schools, and treatments that can be adapted. There is also vital research to be done, and we could be world leaders in that regard. That is a key aspiration that we should endeavour to meet. People with autism need support from school to the workplace, and carers and families also need support. We also desperately need to provide crisis services. Parliament must be inclusive, and I am keen to hear more about what we can do as individual MPs, both in our surgeries and through Parliament, to take these issues forward. We need to make our surgeries autism-friendly places, to ensure that we are role models in service development.

The Minister has many issues to take forward, and I am thankful for her response. I am glad that her door is open, because I might be coming through it on numerous occasions. I am also keen to visit the projects that she has described, which are going to pave the way for progress. It is vital that we take this forward and save lives. Let us work together and do this right across the United Kingdom. Finally, I would like to wish everyone a happy St Andrew’s day.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Happy St Andrew’s day.

Question put and agreed to.

Resolved,

That this House has considered the support available for autistic people experiencing mental health problems; calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework; and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathways.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

I share my hon. Friend’s ambition. I greatly enjoyed visiting his hospital in Barnstaple during the summer, and I have been impressed by the way in which the four trusts in Devon that provide acute services have decided to come together and provide a collaborative pool of, in particular, emergency department staff to ensure that each hospital is adequately covered and there is continuity of service. I think that is a model that we can adopt elsewhere.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The Health Committee heard that to obtain a diagnosis of autistic spectrum disorder, many struggling children and families face a postcode lottery. Will the Department seek to publish baseline data so that we know where trained clinicians are positioned across NHS England, to ensure that workforce planning is undertaken appropriately?

[Jackie Doyle-Price]

I give the hon. Lady an assurance that we will be publishing those data in the new year. It is important that we work hard to make sure that people with autism get a timely diagnosis. That means that we are working to get referrals seen more promptly, while recognising that to give a full diagnosis will take some time.

Baby Loss Awareness Week

Lisa Cameron Excerpts

Tuesday 10th October 2017 Commons Chamber

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to participate in what is now the annual debate on Baby Loss Awareness Week, although, sadly, the only reason why such a debate and such a week of remembrance are necessary is to mark the 3,500 babies stillborn each year across the UK, with one in three of those stillbirths occurring at full-term. That of course does not take into account the babies who die within a year of birth.

All the experts, including Professor Jim Thornton, Professor of Obstetrics and Gynaecology at the University of Nottingham, agree that

“For an otherwise healthy baby to die undelivered near term is, with hindsight, an easily avoidable event. Research to make it avoidable in practice is a priority.”

That is why debates such as this, and any and all measures to highlight stillbirth, are vital.

Although the UK’s stillbirth rate has fallen slightly in recent years, it remains unacceptably and stubbornly high. For too long, this taboo was left in the shadows, too difficult, too upsetting to talk about. As politicians, we all know, what is not discussed, what is not acknowledged, is not addressed and, if not addressed, it cannot be improved. We in this House have been and will continue to work to break that deafening silence. That is our duty on behalf of all those trapped in the isolating silence of grief. Some of us in the Chamber today have experienced that silence first hand.

I think back to 9 June 2016, when I had a Westminster Hall debate on stillbirth, which was hugely emotional, not just because of my own experience but because of the realisation that so many of our babies have been lost over generations, with parents isolated in grief, as this was something that was never talked about in our society, except in whispers. However, since 2016 we have come quite a way. The all-party group on baby loss has done so much to ensure that the issue stays firmly on the agenda. Gradually, as a society, we are becoming more willing to acknowledge this awful event, which affects 3,500-plus babies every year in the United Kingdom, with all the devastation, grief and fallout that it inevitably brings.

Since 2016, I have been in contact with a number of stillbirth organisations such as Sands and Safer Births UK—in fact, too many to mention. Early on, I became convinced that if we accept the analysis of the experts, such as Professor Jim Thornton and others, that for an otherwise healthy baby to die undelivered near-term is, with hindsight, an easily avoidable event—why would we not accept what the experts tell us?—then surely it makes sense to have full investigations when otherwise healthy babies do die undelivered near-term. One third of babies across the UK who are stillborn die at the end of the pregnancy. One in three—this is something that requires serious attention.

That is why last year I asked both the Secretary of State for Health in the United Kingdom Government and the Cabinet Secretary for Health in Scotland, Shona Robison MSP, to instigate coroner inquests in England and fatal accident inquiries in Scotland when stillbirths at full term occurred in an otherwise healthy baby. I appreciate that such processes are expensive, complicated and difficult, but if we consider the lessons that could be learned—what has been missed, what was overlooked and what could have prevented the loss of a baby so close to birth—that can inform good practice and improve the care for future babies. Logically, the need for inquests or fatal accident inquiries would surely diminish gradually over time, as fewer babies would be lost. Of course, we would not just be preventing the loss of babies late in pregnancy either; the lessons learned would inform practice and improve it across the whole maternity service at any and every stage of pregnancy.

When I lobbied for that, I was told by some that it was simply not doable—that I should spend my efforts improving practice in other areas of maternity care: surely it would be best to focus on, for example, ensuring minimum and consistent standards of care across the board. Well, yes and no. The minimum and consistent standards of care that everybody in this Parliament seeks should be embedded in improvement and research, and the use of coroner inquiries and fatal accident inquiries could be a hugely important part of that. It is not an either/or question. 

I am hugely heartened by the fact that, after an initial refusal, the Cabinet Secretary for Health in Scotland, Shona Robison MSP, has agreed that the Crown Office in Scotland should investigate whether there could be fatal accident inquiries for babies lost late in pregnancy. Such a move is not about bringing prosecutions but about learning lessons, informing practice and making sure that when our children are about to be born but something goes wrong, we find out why and use that knowledge to make other babies safer.

Make no mistake: this is a monumentally significant step forward, which has largely been ignored by the mainstream media. I do not know why, but it means that so many who would be comforted by it may not even know that it has happened. However, the significance of this development cannot be overstated. If, after consideration, the Crown Office in Scotland decides for whatever reason that this measure cannot be implemented, at least we will know where we are. We will know what obstacles we are dealing with and can set about removing them. I am also convinced that this measure will mean that fewer of our babies die. When that is shown to be the case, I am hugely optimistic that a similar measure will be adopted in England. That, I feel, has been a huge step forward in the 16 months since my first debate on stillbirth. Credit must also go to the campaigners who have worked hard to achieve this.

This coming Sunday, 15 October, is Pregnancy and Infant Loss Remembrance Day and also would have been my wee boy’s eighth birthday. It is very important that his death, and the deaths of all the babies who have been lost, should not have been in vain. The campaign goes on, so that other babies do not have their lives ended before they even begin.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

My hon. Friend is giving an excellent and emotive speech, and she is conveying an important message about inquiries. Does she agree that it is also extremely important that early miscarriage is well researched? I know from my own experience of early miscarriage that when it happens, people say, “It’s just natural, and there is nothing that can be done.” But the more we look into it and research the causes, the more we can prevent that grief.

[Patricia Gibson]

I absolutely agree with my hon. Friend. If we start our research at the end of pregnancy and work back the way, I think we will be able to spot things much earlier in pregnancy as we learn the lessons that were missed at the end.

No parent should have to bury their child without knowing or understanding why they did not live. That is what drives me on, and I know it drives on many of us who are taking part in this debate. The tragedy of the loss of so many of our babies is that it does not have to be this way. To change that must be, in the words of Professor Jim Thornton, our “priority”.

NHS Pay

Lisa Cameron Excerpts

Wednesday 13th September 2017 Commons Chamber

[Dr Whitford]

If the hon. Gentleman had been following what has been happening in Scotland over the summer, he would know that, following the debate in May, the Cabinet Secretary in Scotland had open discussions with NHS staff side. In June, the Cabinet Secretary for Finance and the Constitution said that our Budget at the end of this year would be looking to get rid of the pay cap. It did not just happen the other week when the programme for Government was announced; it has actually been there all summer. The vacancy rate in Scotland may be 4.5%, but, as the shadow Secretary of State said, it is more than twice that in England. We should be focusing on the fact that nurses and other NHS staff in England are getting almost the rawest deal, which is not right, because they are working just as hard as others.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

Does my hon. Friend agree that it is also extremely important that, if we are to achieve parity between physical and mental health services, we address this issue, particularly for specialist mental health staff—nurses and allied health professionals—who want to work in the service but for whom the work is just not cost effective, as they then seek employment elsewhere?

[Dr Whitford]

That was exactly the point I made at the start of my speech. Although the Royal College of Nursing led the campaign and the image has been of nurses, the issue affects everyone. I echo what the hon. Member for Lincoln (Ms Lee) said—[Interruption.] Well, it was the RCN out at the front.

Adult Social Care Funding

Lisa Cameron Excerpts

Thursday 6th July 2017 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

Loneliness can be extreme in housebound adults and the level of mental health issues such as depression is often high but unrecorded. Will the Government ensure that there is a holistic approach to social care that includes key indicators of mental health and wellbeing?

[Steve Brine]

Yes, the hon. Lady makes a very good point. Those are exactly the issues that will be discussed in the consultation later this year, in which she will, of course, be very welcome to take part.