NHS Shared Business Services

Lisa Cameron Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

All those cases have already been looked at by two sets of clinicians, and so far, on the basis of those two reviews, no patient harm has been identified. However, because we want to be absolutely sure, we are having a third clinical review that will be even more thorough, potentially with more than one set of clinicians, so that we can get to the bottom of this and find out.

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

I understand that the inquiry has focused on patient risk, but has there been any analysis of the impact on patient waiting times, which are also extremely important for patient care? Exactly how many patients have waited longer than they should have for treatment?

[Mr Hunt]

The hon. Lady is right. That is one of the most critical questions when it comes to trying to understand whether there was any actual patient harm. Ordinarily, if a patient was waiting for a test result that did not arrive at their GP’s surgery, the GP would chase it up and get a copy, so there would be no delay in treatment. However, only by looking at the patient’s notes can we understand whether any harm is likely to have happened. So far we have not identified any patient harm, but we will continue to look.

Preventing Avoidable Sight Loss

Lisa Cameron Excerpts

Tuesday 28th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani), who as always made a thorough and insightful speech. She put on the map what needs to be done about preventable sight loss. Given that that is what it is—preventable or avoidable—it is incumbent on the Government to have policies that ensure that patients get access to treatment. Those patients are our constituents and members of our community. We must support their access to treatment, because it will make a huge difference to their lives.

From my background in psychology, I can say that people with sensory impairment often lack confidence. They may become depressed or, if they have sight difficulties, be isolated because they worry about going outside and tripping or falling over. That has an impact on the whole wellbeing of the individual and therefore also that of family members. We must also consider cost-effectiveness. We have heard today that people who require care sometimes cannot get access to it. I know from other hon. Members that there are anecdotal reports of cataract operations being rationed. Such things are not particularly cost-effective ways of using resources. Obviously people who experience preventable sight loss will have falls and require NHS treatment. They may then require hip surgery as well as surgery for their sight loss. These things tend to exacerbate each other. I would like the Government to look at both the treatment that people should have, and deserve to have, and why preventive care is at the heart of a cost-effective NHS.

My grandmother required a number of cataract operations, and the difference I noticed in her following those operations was remarkable. It was almost as if she had her lease on life back. She was able to get out to the shops. She was an individual who really liked to be out and about because it kept her mood up and her spirits high, which is something I would like for everybody who requires it—particularly older adults. My understanding is that, by 2021, 40% of the Scottish population will be over 50—I actually have to include myself in that figure. A significant proportion of sight loss is related to age, and one in eight over-75s and one in three over-90s will suffer significant sight loss. We have an ageing population and we are going to have to look at this issue extremely seriously, in terms of services right across the UK.

The Scottish Government are committed to keeping NHS services free at the point of delivery, and prescriptions and eye tests are currently free of charge, which has resulted in a 29% increase in the number of tests undertaken. That is important, because my understanding is that one of the barriers to preventing avoidable sight loss is that people are not accessing care, which is particularly linked to areas of deprivation. If the UK Government looked at making eye tests free, people in areas of deprivation in particular might not have to choose between a sight test and a meal on the table at the end of the day. In these times of austerity, those are some of the choices that some families unfortunately have to make.

I understand that the Christie Commission report looked at the future of public spending and estimated that 40% of public service spending could be avoided by using a preventive approach. Once again, I emphasise that it is not only morally right and our absolute responsibility to our constituents to ensure that avoidable and preventable sight loss is avoided and prevented, but that doing so is also cost-effective. International research indicates a fourfold return on investment in early eye care intervention, so this absolutely makes sense. Early diagnosis is key.

Let me end by saying that long-term planning is needed. We have made significant steps in policy in Scotland, but I do not want to see a postcode lottery for the rest of the UK. The Minister should look at making sure the policy is commensurate and gives the very best in evidence-based practice for constituents right across the UK.

Health Committee

Lisa Cameron Excerpts

Thursday 16th March 2017 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend for his important question. We absolutely looked at that issue and specifically mentioned it in our report. He will know that part of the problem is that irresponsible reporting can sometimes lead to contagion. We know that when local areas work together closely to identify suicides, particularly early clusters, measures can be taken—people can go into workplaces, schools and colleges—to provide support and stop it. It does, though, require that we notice it early, so the Committee urges coroners to work with local authorities and public health teams to ensure that they are aware of the high risk of suicides spreading.

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

I thank the Select Committee and the hon. Lady for the report. The Scottish National party welcomes the recommendations and urges that they are fully taken into account. We particularly urge the Government to commit to rolling out crisis intervention teams and support to prevent suicide, so that people in such circumstances can be followed up directly. Suicidal individuals are not always mentally ill, and lengthy waiting lists for psychological treatment or attendance at A&E are sometimes not the most appropriate options. Liaison psychiatry is under-resourced, and urgent follow-up through crisis support is needed. How will we ensure liaison between services? Only when that occurs seamlessly between health, social care, community services and criminal justice will we prevent suicidal individuals from falling between the gaps.

[Dr Wollaston]

I thank the hon. Lady for highlighting a really important point about the need for communication, not only with families but within services. One problem is that there is what happens in local authorities and what happens in the health service, and too often there is not sufficient communication between the two.

Alcohol Harm

Lisa Cameron Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce]

I absolutely agree. I am aware of that legal advice. I hope that the Government will do so and that the Minister will take note of that.

In preparing our report, the all-party parliamentary group discovered shocking harm, particularly to people working in our emergency services. I would like to refer to evidence we obtained from an emergency services doctor, Zul Mirza, whom I commend for his work in this area. He talked about how patients coming into his wards inebriated not only can be violent towards staff, but on many occasions damage valuable equipment needed by other patients. Our report also found that over 80% of police officers have been assaulted by people who are drinking. I was deeply concerned to hear one police officer tell us this:

“There is one thing that is specific to female officers and that is sexual assault. I can take my team through a licensed premise, and by the time I take them out the other end, they will have been felt up several times.”

That is shocking.

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

I thank the hon. Lady for bringing this extremely important debate to the Chamber. Given the figures she describes, does she agree that alcohol-related aggression needs to be addressed in terms of treatment? Having worked in the criminal justice system, I agree on the wide-scale aggression that is found in A&E departments at weekends and that the police face mainly at weekends, but also on many days of the week. Given that a low number of Members have turned up to this debate, does the hon. Lady agree that politicians should be taking the issue more seriously? More politicians could probably be found in the bars of Westminster today than here in this debate. We should be addressing this problem.

[Fiona Bruce]

The hon. Lady is absolutely right. It is tragic that only 6% of dependent drinkers in this country access treatment, despite it being very effective. We need to do much more to make treatment available to them.

A concerning finding of our all-party parliamentary group’s report was that many of those in the emergency services themselves are suffering from depression or are even thinking of leaving the services simply because coping with this kind of pressure day in, day out is proving too much for them. We must tackle that.

After reflecting on the many and varied aspects of alcohol harm in this country, the Public Health England report goes on to say:

“This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.”

What does this Department of Health review recommend? It talks about tackling three things: affordability, availability and acceptability. Affordability means price; availability means the ease of purchase—in other words, the number of outlets and the times at which alcohol can be bought; and acceptability means tackling our drinking culture. I want to give other Members time to speak, so I will not talk in detail about all those things, but I will touch in particular on affordability.

I had the privilege of asking Public Health England’s senior alcohol adviser this week what his top recommendation to Government would be to tackle alcohol harm, in the light of this substantial report. Without hesitation, he replied that it would be tackling affordability and putting in place policies that increase price. The report is absolutely clear:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement. For example, an increase in taxation leads to an increase in government revenue and substantial health and social returns.”

However, since 2012 the Government have done the opposite: they cut the alcohol duty escalator. The report states:

“According to Treasury forecasts, cuts in alcohol duty since 2013 are projected to have reduced income to the Exchequer by £5 billion over five years”.

The very first recommendation in the 2012 strategy was to implement minimum unit pricing. Indeed, the most recent review states that minimum unit pricing is

“a highly targeted measure which ensures tax increases are passed on to the consumer and improves the health of the heaviest drinkers. These people are experiencing the greatest amount of harm.”

In the foreword to the 2012 strategy, the then Prime Minister said:

“We can’t go on like this… So we are going to introduce a new minimum unit price.”

Five years on, that has still not been done, while the alcohol duty escalator has been cut, even though the No. 1 policy recommendation to tackle alcohol harm in the Government’s own review is to address affordability. Will the Minister, who I know is a good woman, now take a lead on this and make it happen?

The Government introduced a ban on the sale of alcohol below the cost of duty plus taxation, but the review states:

“Bans on the sale of alcohol below the cost of taxation do not impact on public health in their current form, and restrictions on price promotions can be easily circumvented.”

Let us consider for a moment white cider products such as Frosty Jacks, which are almost exclusively drunk by the vulnerable, the young, the homeless and dependent drinkers. Just £3.50 buys the equivalent of 22 shots of vodka. The price of a cinema ticket can buy 53 shots of vodka. The availability of cheap alcohol, bought because of its high strength, perpetuates deprivation and health inequalities. Homeless hostels say that time and again the people staying with them drink these products, and many are drinking it to death.

Ciders of 7.5% ABV attract the lowest duty per unit of any product, at 5p, compared with 18p per unit for a beer of equivalent strength. There simply is no reason not to increase the duty on white cider, and 66% of the public support higher taxes on white cider. It is a matter of social justice that the Government should do that, and do it quickly. It need not impact on small, local brewing companies, which could have an exception, and it will not impact on pub sales. Tackling it would benefit the youngest and most vulnerable and save lives.

As I mentioned, the ban on below-cost sales has had no impact on sales of strong white cider. The current floor price of white cider, at 5p to 6p per unit—that is duty plus VAT—is so low that it can be sold for 13p a unit. Will the Minister ask our right hon. Friend the Chancellor of the Exchequer to increase the duty on white cider in the spring Budget on 8 March? This is not the first time that has been asking. Three hon. Members —my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) and I, and no less a person than the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston)—tabled an amendment to the Finance Bill last September, asking for the duty regime for white cider to be reviewed. I urge the Minister to read the excellent speech made by my hon. Friend the Member for Enfield, Southgate on 6 September. Indeed, my hon. Friend the Financial Secretary to the Treasury, who responded, said that the matter needed to be looked into.

Will the Minister press the Chancellor not only to work with her on that, but to introduce the promised minimum unit price and reintroduce the abandoned alcohol duty escalator, so that the tax system not only tackles alcohol harm, but incentivises the development of lower strength products and provides much-needed funding to help with treatment? Looking at all the evidence, we see affordability come out again and again as the most important driver of consumption and harm. Increasing the price of alcohol would save lives without penalising moderate drinkers.

Apart from tackling price, there are of course many other recommendations, both in the Public Health England report and in the APPG report, which came out a week before, that I would be grateful if the Minister would consider. I am grateful that she has already agreed to meet the APPG to discuss our report. Our chief recommendation is that the Government develop a cross-departmental national strategy to tackle excessive drinking and alcohol-related harm. Will the Minister take a lead on that?

Another key recommendation in the APPG report, which again is supported by the PHE report, is the implementation of training and delivery of identification and brief advice programmes and investment in alcohol liaison teams. I remember hearing one suggestion for brief advice to be given whenever anyone is having their blood pressure tested. Just in those few moments, it would be effective for whoever is doing the test just to ask the individual, “How is your alcohol consumption? Do we need to discuss that?” That kind of brief intervention can make people stop and think.

We must pursue earlier diagnosis of those with alcohol problems or potential alcohol problems. There are 1.5 million dependent drinkers, only 6% of whom access treatment. Many people are just drinking in excess of the chief medical officer’s low-risk unit guidelines. In fact, Drinkaware’s research shows that 39% of men and 20% of women are drinking in excess of those guidelines. It says that nearly one in five adults drink at hazardous levels or above. Many people need help through early intervention programmes, as well as more comprehensive treatment and support. Why are we not providing that when we know that it works?

Implementing such interventions is cost-effective for the NHS. I will give a powerful example that was drawn to my attention by Alcohol Concern. St Mary’s hospital in London has trained staff to give brief advice to patients presenting at A&E. It has designed the one-minute Paddington alcohol test to identify and educate patients who might have an alcohol-related problem. That is called the teachable moment and it has resulted in a tenfold increase in referrals to the alcohol health worker, who then carries out further brief interventions, resulting in a reported 43% reduction in alcohol consumption by the people referred. That is a very effective intervention.

It is interesting to note that the Public Health England report confirms that health interventions aimed at drinkers already at risk and specialist treatment for people with harmful drinking patterns are effective approaches to reducing consumption and harm and

“show favourable returns on investment.”

However, it points out that their success depends on large-scale implementation and funding. Will the Minister look at how her Department can give a national lead to share and implement best practice in this field, such as that which I have described?

I would like to say much more on the subject, but I will turn now to the issue of drink-driving. Unpopular as it might be to talk about this in policy terms today, the Public Health England report is clear. It states:

“Enforced legislative measures to prevent drink-driving are effective and cost-effective. Policies which specify lower legal alcohol limits for young drivers are effective at reducing casualties and fatalities in this group and are cost-saving. Reducing drink-driving is an intrinsically desirable societal goal and is a complementary component to a wider strategy that aims to influence drinkers to adopt less risky patterns of alcohol consumption.”

That could not be clearer. The UK is out of line with almost all of the rest of Europe when it comes to drink-driving alcohol limits.

Social Media and Young People's Mental Health

Lisa Cameron Excerpts

Wednesday 2nd November 2016 Westminster Hall

[Sir Alan Meale (in the Chair)]

Mr Donaldson, everybody gets worried and wants more time. Don’t worry about it.

[Dr Cameron]

rose—

[Sir Alan Meale (in the Chair)]

Dr Cameron, you have five minutes.

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

Thank you once again, Sir Alan, for your excellent chairmanship today. I thank the hon. Member for Cheltenham (Alex Chalk) for bringing this crucial debate to Westminster Hall and for providing such a comprehensive review of the field. He highlighted the extraordinary pressures on the mental health of our young people today and the importance of prevention, research and specific interventions.

I begin by declaring an interest: I have worked in mental health as a psychologist and continue to maintain my skills and engagement in line with my professional registration requirements. In the short time I have today, I will cover the positives and negatives of social media, sum up the thoughtful contributions from Members and make recommendations to the Minister.

We have heard that there are many aspects to the new world of social media. Indeed, as a candidate I had never before tweeted but was told that it was crucial to the campaign and that I needed to develop a social media profile. Social media are coming to everyone of all ages, including me. I have noticed that they make people question themselves: “Is this relevant? Am I witty?”—not usually, in my case—“How do I phrase this? Will I make a mistake and be criticised?” They can help us to link with many people but are also a pressure. I was interested to learn about Instagram today from my youthful hon. Friend the Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson)—something else that I hope I never have to learn to use.

We know from psychological research that, for introverted teenagers, linking with peers can be easier through social media than in person. Social media can have an affirmative effect, as we heard from the hon. Member for Strangford (Jim Shannon), and can help to build self-esteem and friendship networks. However, some problems emanate when young people’s social lives begin to completely link with social media and online activity, rather than with active involvement with others for some part of the day and building friendship networks of people with whom they can spend quality time and engage. One key question about social media must be how much is too much and how much is healthy.

In a 2012 survey, 53% of social media users in the UK said that social media had changed their behaviour. Of those, 51% said that the change was negative because of a decline in confidence. Young people are particularly vulnerable to peer pressure and negative comparison. They may feel inadequate because they do not seem to have as many friends as their peers, as we heard from the hon. Member for Ogmore (Chris Elmore), or because they feel that they are not physically perfect. Research indicates that this trend may affect girls more than boys, but none the less it can affect all our children and young people.

Millennials apparently take around 25,700 selfies in their lifetime. A recent NHS report has shown a large increase in the number of young women suffering from mental health problems as a result of selfie culture—we heard that point put forcefully by the hon. Member for Neath (Christina Rees) and my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson). We also heard about dangerous websites that can encourage young people to self-harm or to reduce their weight to critical proportions. Earlier this year, Instagram introduced anonymous reporting tools and a support network designed to tackle issues from self-harm to eating disorders. Some of the answers may be online, but most definitely not all of them are.

Hon. Members have spoken eloquently about the fear of missing out. There is increasing pressure on young people to be part of the group and to be included in online activity constantly, so they become agitated, anxious and find it difficult to switch off and resume everyday activities. It almost becomes an obsession.

Cyber-bullying was raised by the hon. Member for Cheltenham and by my hon. Friend the Member for Glasgow South (Stewart Malcolm McDonald), who spoke eloquently about his constituent. It is unacceptable and can lead to suicidal behaviour, particularly in vulnerable populations.

On the sensitive issue of sexting, it appears, worryingly, to be much more common. Sexting affects a considerable proportion of young people, who may feel pressure to sext their naked body parts to third parties. Those photographs can then find their way online, to mentally scar those young people and leave them literally exposed to the world in perpetuity.

It is clear that society has moved online, and our responses need to take account of that. I ask that the Government look at standardised online materials for children and adolescents to help them to prevent harm caused by social media use and to take precautions for themselves. I also ask that police service resourcing be supported to take action against sites that specifically focus on young people and aim to undermine their mental wellbeing. As always, we must target the online predators who may target young people. Safeguards for online sites must be introduced. Children and young people need education on safe online usage, as do their parents. As the hon. Member for Cheltenham eloquently said, we need to develop research and treatment to help people who have had their mental health damaged online. There is a lot to take forward, but we must do so with care, together.

Young People’s Mental Health

Lisa Cameron Excerpts

Thursday 27th October 2016 Commons Chamber

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

I thank the Youth Select Committee for an excellent and comprehensive report, compiled by our young parliamentarians with the backing of experienced evidence. It is extremely thorough, and a credit to them. I thank the Backbench Business Committee for scheduling this debate and the hon. Member for Dulwich and West Norwood (Helen Hayes) for leading it.

I must begin by declaring a professional interest, having worked for 20 years as a clinical psychologist in mental health. I continue to maintain my skills and engagement in line with the professional requirements of my registration. Just after the election, I had the great privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis to depression and anxiety, trauma, and eating and adjustment disorders. Childhood developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are often also included in the sphere of mental health. I would welcome future debates on those important conditions too, because I feel that we shall not have time to do them justice today.

As a member of the all-party parliamentary group on autism, I have a particular interest in this field. I commend the recent report by Ambitious about Autism, which, worryingly for us all, highlights the fact that 80% of children with autism experience anxiety on every single day they attend school. For this crucial group, we must target our resources and make sure that early diagnosis and support are provided for the young child and for the whole family. More than half of mental ill health starts before the age of 14, and 75% before the age of 18. Early and effective intervention in and prevention of mental ill health during childhood are absolutely key in reducing morbidity. The quicker we intervene, the more effectively we intervene, and it is also more cost-effective for the NHS.

In 2014, the health improvement efficiency targets were adopted in Scotland and across the UK, meaning that patients should be seen, from referral to assessment, in 18 weeks, including in CAMHS services. The figure that I have researched suggests that in Scotland 84% of children and adolescents are now treated within this time, and we have set a benchmark of 90%. We have therefore come a long way in this regard, but we still have further to travel. There are now significantly increased referral rates. Although that may mean increased numbers of sufferers, it may also mean that stigma is reducing and people feel more able to present, so it is a mixed picture. However, mental health services in Scotland, and across the UK, are not the finished article. We should continually strive towards improvement, and that should always be guided by patient need and by research underpinning the most effective clinical practice.

As we have heard, mental health problems in childhood are extremely serious. At worst, they can destroy educational potential, or at least impede it, and impede relations with peers and within the family. They can also lead to suicide and self-harm. Difficulties must be assessed and recognised at an early stage. In Scotland, widespread staff training has been undertaken to try to ensure that we can pick up on mental health issues within this age group. We have rolled out cognitive behaviourial therapy, family therapy, interpersonal therapy and specialist interventions such as those for eating disorders, with a focus on seeing patients as close to home as possible. We must make continual progress on this.

There needs to be additional resourcing for tier 4 services for in-patients. For children and adolescents, in-patient treatment should be a last resort, because it takes children away from the family home and pathologises their difficulties. Best practice highlights intensive outreach approaches that enable children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services may suffer psychosis, intractable eating disorders, severe obsessive compulsive disorders, and a variety of neurological conditions. There are currently 48 beds available in Scotland, and £8 million has been pledged to build a new unit in Dundee for children and adolescents with mental health problems. We must ensure that service provision meets needs. My clinical experience suggests a lack of available tier 4 beds in forensic and learning disability CAMHS, and that should also be addressed.

We need better communication channels between departments when children’s care is transferred between professionals, and importantly, as has been described, at key stages of development such as moving from adolescence to adult services. There requires to be a component of the training programme for general practitioners in primary care that identifies children’s mental health issues. I would include symptoms of autistic spectrum disorder and attention deficit hyperactivity disorder within that training. We need to shorten the time from presentation to referral, and picking up symptoms timeously assists greatly with this. As with diet and exercise, good mental health and well-being has to be normalised. These are all fundamental coping skills that impact on everyday aspects of our functioning and deserve to be slanted more towards health and well-being than diagnosis.

Access to mental health specialists in schools is merited, as well as mental health awareness and training, particularly training for staff in schools so that if someone is experiencing a mental health problem the staff can pick it up at a very early stage and help them to access services. Specialist training for teachers would be a positive step forward. Education for children is also crucial so that they can identify when they are struggling, identify what makes for good mental wellbeing and seek help when needed, and so that they can identify whether a peer is struggling. Young people like to be, and should be, fully involved in their care.

We need to modernise our approach to mental health services for children and adolescents. We must embrace IT and social media methods of communicating with young people, because in the modern world, it is often how they communicate. In previous debates I have mentioned a project in Scotland called SafeSpot, which is an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. That is a good step forward. I am aware that recommendations for online standardised and approved resources would be a key step.

As has been mentioned, we must address bullying, particularly online bullying, which appears to be on the increase and which badly affects children’s lives. In fact, we must address bullying everywhere. Only this summer, when I was discussing mental health, I was informed by an MP who was a fellow member of a delegation that MPs have a high suicide rate—something that I was unaware of. We must lead by example. We must ensure that mental health and wellbeing are addressed in all aspects of life, and we must provide our own model.

There remains a lack of empirical data regarding effective interventions for young people with co-morbidity issues, by which I mean mental health difficulties coupled with learning difficulties or substance use. That has to be built on through research and treatment programmes. I would also like to touch on services for looked-after and accommodated children—particularly those who have violence risk needs or self-harm needs—who are some of the most severely disadvantaged in terms of services and the magnitude of difficulties that they present with. Further service provision for specialist groups and underpinning research are crucial, and I am extremely pleased that the First Minister will be pledging to support those groups.

Given that the weight of evidence for child and adolescent mental health services is in favour of psychological rather than pharmacological interventions for the majority of presentations, clear structures must be in place to support the delivery of effective evidence-based psychological therapies for children and adolescents. The number of child and adolescent mental health services psychology posts have doubled in Scotland, and I welcome that, but we need to continue and strengthen that progress. Uptake of such services has always tended to be poorer among people from socially disadvantaged backgrounds, and in such cases an assertive outreach approach may be required to ensure that some of the most vulnerable and disadvantaged children and families do not slip through the net.

To summarise, mental health services require parity of esteem and therefore considerable funding. I believe that this goes beyond party politics. It is crucial that we tackle it meaningfully in a cross-party manner, sharing best practice across the whole United Kingdom. We need real progress to reach children and adolescents and to help all our children achieve their full potential.

Psychosis: Early Intervention

Lisa Cameron Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb]

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.

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

I thank the right hon. Gentleman for securing this important debate. Does he agree that although not everyone will suffer mental health problems in childhood, it is important that mental wellbeing is focused on in schools—both primary and secondary—to ensure that good mental health is promoted?

[Norman Lamb]

I thank the hon. Lady for that intervention, because I totally agree. When I was Minister, we set up a taskforce to look at how we could modernise children’s mental health services. It published a report last March called “Future in mind,” the whole focus of which is on shifting fundamentally towards prevention: establishing wellbeing, particularly in schools, and intervening much earlier to stop deterioration ever happening. That approach is much more effective. It can help teenagers through difficult years as they grow up, but it also stops the enormous cost to the system later of neglecting those problems.

Psychosis costs the NHS £11.8 billion a year. That is a vast cost. Only 8% of people who suffer from psychosis are in work, so the cost of the illness to society is enormous. The evidence of the effectiveness of early intervention in psychosis is overwhelming. It is clear that if we intervene quickly, we can have an impact on that condition, stop it in its tracks and give sufferers the chance of a good life, which the rest of us take for granted. If we neglect the condition, those people will almost inevitably suffer lives on benefits and with difficult relationships, at—this is critical—enormous cost to the state. Analysis shows that if we invested £1 in services for early intervention in psychosis, the return on that investment over a 10-year period would be £15. We might ask, “What is the reason not to do that?” It is overwhelming common sense. It is both morally right and the economically sensible thing to do.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the right hon. Member for North Norfolk (Norman Lamb) for securing this extremely important debate. I declare an interest, having worked as a clinical psychologist for 20 years in the NHS, and as a continuing member of the British Psychological Society, our professional body.

I shall start by giving a little context. I am heartened by some of the progress that has been made and by initiatives on mental health taken by Governments in the UK and Scotland over the years. When I started out, it was quite commonplace for patients to wait up to or more than a year for treatment. There appeared not to be any urgency about dealing with the waiting list and waiting times. That has improved very much, and we have waiting list standards. The HEAT targets—health improvement, efficiency and governance, access and treatment targets—focus service providers, policy makers and resources. So things are improving, but we clearly still have much work to do. I concur that we need to work in a conjoined way across the UK and share best practice models in doing so.

The service when I started in practice clearly was not good enough. Patients had been waiting far too long by the time they came into treatment. Often they had been admitted to hospital in an acute situation—perhaps they were suicidal—or had had multiple episodes of psychosis, and we were not providing the best possible standard of care. Psychosis is a distressing illness, which tends to be long-term, although people can recover at an early stage if we pick up their symptoms and provide the appropriate care timeously.

In psychosis, people experience symptoms of paranoia and, often, delusional belief systems that take them outwith reality. They may experience visual and auditory hallucinations. It is distressing for the person and also very much affects their family and those around them, and we must take it very seriously. Although it affects quite a small proportion of the population, it has huge ramifications for family relationships.

[Gavin Robinson (Belfast East) (DUP)]

The hon. Lady is building on an impressive speech by the right hon. Member for North Norfolk (Norman Lamb). Does she accept that while it is right to pay attention to how quickly people get treatment after diagnosis, the biggest barrier to early intervention and treatment is securing diagnosis? I have personal experience, as my wife struggled for two years to get a diagnosis. Once she got it treatment was put in place, but it was far too long to wait. Until we crack that nut and, rather than dismissing people’s symptoms and struggles, deal with them practically, sympathetically and professionally, early intervention is only a myth to be discussed. We need the diagnosis first.

--- Later in debate ---

[Dr Cameron]

I thank the hon. Gentleman for that intervention about his personal and family experience. What he says is totally true; the issue is about shortening the gap between presentation and emergence of symptoms, and diagnosis. That is also true of other mental health problems and developmental disorders. Autistic spectrum disorders are the ones that stand out to me, particularly because parents often struggle for years to obtain a diagnosis, and therefore their children do not receive appropriate intervention early enough. They struggle with understanding their child and family relationships can deteriorate as a result, so I very much concur with the hon. Gentleman’s point.

That is why the mental health taskforce setting a standard for England is such a positive development. It is intended to achieve parity of esteem, but again, we cannot just have that in words—we must have the action to follow. The initiative and standard also establish that this is a national priority, which is important, because it has not been in the past. Mental health services have often been seen as an adjunct, which is not good enough, because we know that, for instance, one in four people experience depression in their lives, while many more experience other types of mental health problems, such as anxiety.

Although only a small proportion of the population will experience psychosis, mental health problems and difficulties are widespread. Most of us will at some point experience someone in our life having mental health difficulties, so it is important that we have the standard in place and that care is within two weeks from referral. It is also really important that the data are recorded, because services have to be standardised. That is the other issue to consider, because some trusts can often implement things more quickly than others. We need to ensure there is not a postcode lottery across services and that people can access good mental health provision wherever they may be in the country. I would welcome that.

Psychosis requires multi-professional services, so a specialist team is required. Providing such a team is often labour-intensive and costly, but we should focus on the cost-effectiveness over the long term. As the right hon. Member for North Norfolk said, if we do not intervene early, the cost to society, the health service and people’s lives far outweighs the cost of the NHS provision that we must make. Standards focus policy makers on resources and ultimately improve care. The Scottish Government are currently undertaking a consultation on their mental health strategy, and early intervention and prevention will be key pillars in that. We now have a Mental Health Minister, Maureen Watt, who will be focusing on the delivery of the strategy, which will be informed by carers, service users, professionals, research and best practice.

One project I am aware of is the Esteem project in Glasgow, run by my colleague Suzy Clark, which covers Argyle and Clyde and is an early intervention service for psychosis. I understand that there is no waiting list and patients are usually seen within five days of referral, which is a huge change from the days when I started out. If patients are admitted to hospital they are assessed at the service within 24 hours, so people can feel supported straight away. It is very much a holistic service, looking at psychiatry with a medical model but also looking at psychological interventions and family support.

In the National Institute for Health and Care Excellence guidelines, cognitive behavioural training for psychosis is important. It helps people who are suffering from the positive symptoms of psychosis to begin to reappraise those symptoms, so that they can once again make a connection with reality and begin to be rehabilitated back into day-to-day life. Behavioural family therapy is also extremely important. As I have mentioned, psychosis affects not just the person who suffers but their whole family and social circle.

People can suddenly find themselves in a caring role, and research indicates that spending 10 hours and above per week as a carer can be a challenge to someone’s wellbeing. Once again, we can see the ramifications of avoiding putting best practice in place and not giving early intervention the priority it deserves. Depression is common in carers. They describe a need for information, practical help and emotional support, often from other people in a similar situation. Crucially, the outcome for and individual who suffers psychosis also partially depends on their relationship with their carer and family. That is why services and treatment have to look at the individual in a holistic manner and make sure that the available interventions encompass the family.

The Esteem project provides CBT for psychosis and behavioural family therapy. It also helps individuals to look at early warning signs and identify their symptoms at an early stage when they start to become unwell, so that they can contact appropriate providers if they have a subsequent episode. Outcomes from the first episode study by Professor Gumley at Glasgow University show massively significant and favourable outcomes following early intervention and service involvement. I must mention that Tony Morrison is also leading on the issue at Manchester University, so we can see that areas of expertise are developing right across the UK, which is heartening. We need to focus on early intervention; it is key. It leads to better prognosis, has better outcomes and reduces the risk of further relapse. It helps a person reintegrate into society, assists their carers and family and is cost-effective.

I welcome the Minister to her role, and I urge that the direction that is given is the best practice that has been recommended. We need that for service delivery, patient care, clinical effectiveness and cost-effectiveness. We must ensure there is parity of esteem for mental health.

--- Later in debate ---

[Kerry McCarthy]

I very much agree, and I would love to see more research into the reasons for that. We know that early intervention is crucial and that if there is intervention after the first episode of psychosis, it can be deflected further down the line. It may be that young men’s reluctance or the lack of access to those services means that they go on to develop full-blown psychosis, which then blights their adult lives. There could be all sorts of reason. I have heard my hon. Friend speak about this before. I know she thinks it is a really important issue, and I agree with her.

Young people are even more marginalised. I have the Riverside unit for young people in my constituency at Blackberry Hill hospital. It is part residential, part day placements. I visited it recently. If the spaces are full, a number of young people get sent a considerable distance from home and away from their friends and families for treatment, which is not ideal. If we are trying to deal with young people in very vulnerable circumstances, displacing them from their families and support networks is obviously wrong.

Dr Dominique Thompson, who is in charge of the GP services at the University of Bristol, has given me figures in the past about the proportion of the casework of GPs at universities that is now on mental health-based issues, and it has grown exponentially. That is everything ranging from anxiety, stress and depression right through to severe psychosis. I make a plea that the health services at universities are not the same as ordinary neighbourhood GPs; they need particular support. They deal with young people who are away from home and away from their support networks. We know that GPs are under pressure—particularly in terms of recruitment, which is a debate for another day—and it is important they have the resources to deal with that.

I want to mention briefly one source of help that is available to GPs. I met a group of researchers yesterday who are part of the Avon and Wiltshire Mental Health Partnership NHS Trust and are based at Blackberry Hill hospital in my constituency. They do something called BEST—best evidence summaries of topics—in mental health, which is a web-based service. Basically, these experts look through all the information available and distil it down to easy paragraphs for clinicians, so that rather than having to wade through all the material on the internet, clinicians are given some guidance as to what they are likely to be looking at and the likely best treatments. The funding for that service is under threat. A cross-party group of MPs from the Avon and Wiltshire area met those researchers yesterday. We think that the service should at the very least be piloted, with a view to rolling it out nationally, because it is a really valuable resource. We are going to write to the Minister about that, but I wanted to flag it up today.

Finally, I was looking this morning at the NICE guidance on early intervention in psychosis access. It pays passing reference to substance abuse, saying:

“Around 40% of people with first episode psychosis misuse substances at some point in their lifetime.”

I would like to see more research done into cannabis-induced psychosis. It is clear to me—partly from anecdotal evidence, but there is research out there—that partly because of the stronger strains of cannabis that are now available, more people are presenting with cannabis-induced psychosis. There may be a connection between that and people going on to develop full-blown psychosis, or people may have a cannabis-induced psychotic episode and then recover. Speaking partly from personal observation, I think that in some cases drug use makes it more difficult to diagnose when people are suffering first-time psychotic episodes. I would like to see more research into that.

[Dr Lisa Cameron]

The hon. Lady is making an extremely valid point in terms of comorbidity. Comorbid substance abuse often precludes people from treatment, and they can be turned away from treatment centres. As she said, it is very common and should not mean that people cannot access treatment.

[Kerry McCarthy]

There is also the issue of whether people feel they are self-medicating by smoking. They may feel that it helps their symptoms, whereas it quite often exacerbates their symptoms.

Stillbirth

Lisa Cameron Excerpts

Thursday 9th June 2016 Westminster Hall

[John Howell (Henley) (Con)]

I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing the debate. She has spoken with great passion from a personal perspective. We have all been moved by what she has said. It was very powerful.

I want to make a short contribution on behalf of a constituent and a member of my family. My constituent wrote to me to tell me about how she lost her first child to stillbirth:

“This life altering event has led to us being placed into a world we never knew existed. Sadly, the baby loss taboo leaves many unsupported and prevention affected.”

She has been trying to get information from her clinical commissioning group on what is happening to ensure that such things do not happen again and that more women can be protected. What she has got back from the CCG so far has been a general statement of Government policy, which includes the four principal activities that CCGs are asked to concentrate on: reducing smoking in pregnancy; monitoring foetal growth; raising awareness of foetal movements; and improving foetal monitoring.

That is all very well—I put great emphasis on the improvement of foetal monitoring, so that the information is provided and is fed back to the individual concerned—but my constituent also wants detailed information about what the CCG is doing to ensure that the issue is addressed. The CCG operates across two obstetric units and four midwife-led units and has a small number of babies delivered at home each year. She has not been able to get detail about what that CCG will do to address the situation for the future. I hope we can send a strong message to CCGs around the country that concentrating merely on the Government’s four key objectives is not good enough. What we need is the detailed information on how they are going to go about dealing with this issue through their sustainability and transformation plans to provide reassurance for women who are in this situation.

I appreciate the effect that stillbirth has on women, but it is not exclusively a woman’s problem. The fact that stillbirth occurs is a problem that affects the whole family, and it affects men as well. I know that, to my own cost, through a family incident. It is essential to bear in mind the impact on the mental health of men who are involved in cases of stillbirth and simply do not know where to turn in what is a completely traumatic experience. I urge the Minister to concentrate on providing information about what the Government are doing for the whole family and for the wider community.

My next point is that essentially we are talking about an artificial distinction here. We are talking about the distinction between miscarriage and stillbirth and about a particular period, which comes at around 24 weeks. That is totally unfair. Before the 24 weeks, parents are given no chance to grieve for the baby who has been lost, or to go through the process of putting their lives back together again. We ought to look at that to see whether that distinction is still relevant.

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

Does the hon. Gentleman agree that counselling should be available for the whole family on request? We should be seeking to take that forward across the whole UK.

[John Howell]

The hon. Lady is absolutely right. Counselling needs to be provided for the whole family unit to see them through a very traumatic experience.

NHS Bursaries

Lisa Cameron Excerpts

Wednesday 4th May 2016 Commons Chamber

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

I must declare an interest due to my work in the NHS and having had the privilege of a grant when training to be a doctor.

The NHS is one of our most esteemed public services, but there is a long-standing shortage of qualified healthcare professionals. While the current bursary system for nursing and allied healthcare students in England may not be without issue, the UK Government’s proposed changes are concerning, as is the manner in which they have been presented, with detailed consideration of the impact somewhat lacking.

As we have heard, the UK Government have proposed changes to the current NHS bursary system. Instead, healthcare students will be required to pay tuition fees and will be subject to the same standard loans-based system to which other students in England are subjected. The UK Government have indicated that they expect the reforms to create up to 10,000 additional nursing and health professional training places over the course of the current parliament. However, that appears to be narrow-sighted. The proposed move to a system that relies on students funding themselves by taking on significant debts has raised substantial concerns among unions, professional bodies and students. One of the key fears is that such a move could be a barrier that deters prospective students from entering the profession. I stand here as the first doctor in my family, and I have to say that I would not have considered applying if it had meant racking up debt. I am particularly concerned about access to doctorate courses and postgraduate requirements. Will we create an elite workforce based not on ability, but on means?

Unison estimates that a student undertaking a three-year, 30-week course outside London under the new scheme will graduate with a debt of at least £51,600, plus interest and any overdraft and commercial debt.

[Richard Graham]

The hon. Lady’s achievement as the first doctor in her family is to be applauded by us all, but does she recognise that there are many people who do not think that university is for them? The two-year apprenticeship course offered by the new nursing associate route will provide them with a real opportunity to get into the NHS and maybe to go on to become a full nurse later on.

[Dr Cameron]

I want to see a widening of access to training schemes in the NHS, and I would hope that that would be properly funded and that we do not rely on NHS staff doing other jobs while dealing with the stress of training. We should invest in and fund them properly, letting them know that NHS staff are invaluable.

For many, loans may be higher due to the additional costs of longer courses or of courses within London. As I said, I am particularly concerned about postgraduate courses and doctorate trainees, who may not be able to afford further loans that will add to their debt. It is likely that debt could be considerably higher for the majority of healthcare students. It is naive to think that larger loans will not be a psychological deterrent, especially to those from poorer or non-university backgrounds or to mature students and career changers, who may have additional financial responsibilities or debts from first degrees or family life.

The demographic of students on nursing, midwifery and allied health professions courses tends to be different from other student populations, as we have heard. They are more likely to be women, from black and minority ethnic backgrounds, parents or mature students. It is therefore likely, and a real concern, that abolishing bursaries will reduce diversity, foster inequalities and discourage potentially high-quality applicants.

[Angela Rayner]

The hon. Lady is making an important point. Returning to something the Minister said, the frustration for me is that I was a Unison rep in homecare before coming to this place, and we were able to give unqualified women access to a foundation degree when they were healthcare assistants. They could then do a vocational degree and get into hospitals in much the same way as what the Minister claims is not currently available. It is important that that route remains open and that its users, mature students in particular, do not get disadvantaged because of the thousands of pounds-worth of debt that they would take on at the end.

[Dr Cameron]

The hon. Lady makes her own point. It is important that people from all backgrounds are encouraged to enter our NHS. The UK has a diverse society and we must ensure that our healthcare staffing system reflects that and supports those from all backgrounds to enter it.

It is not enough just to increase numbers by creating an open market for training. In order to ensure a quality service, it is crucial that student placements are well planned, well supervised and well distributed between the various areas within the service, so much consultation is required. In response to the Government’s proposals, a former chief executive of the Royal College of Nursing commented:

“The last thing we need are disincentives to recruitment. We should be doing everything possible to attract applicants, as the country needs more nurses now than at any other time in its history.”

[Christina Rees (Neath) (Lab)]

The hon. Lady is making many valid points. If someone lives in Wales and wants to study at an English university, it is proposed that the bursary will be stopped. If someone lives in England, Scotland or Northern Ireland and wants to study nursing, midwifery or an allied health profession at a Welsh university, the Labour Welsh Government will pay the bursary. Taking that to its logical conclusion, the numbers will decrease in England and increase in Wales, Scotland and Northern Ireland. Of most concern is the fact that the UK Government did not commit to undertake an impact assessment of cross-border applications before proceeding with the changes. Does the hon. Lady think that they should have?

[Dr Cameron]

Once again, the hon. Lady makes her point very well. I believe we need to staff the NHS well right across the UK. Impact assessments may require consideration down the line if there is a shortage in England as a result of this policy. I hope that answers her question.

In Scotland, the SNP Government recognise the value of investing in our NHS, providing a support package that is hugely generous in comparison with that in England. The nursing and midwifery student bursary in Scotland provides all eligible students with a non-income-assessed and non-repayable personal allowance of £6,578 per year, excluding additional allowances. That can be topped up by a range of income-assessed allowances, and it comes in the context of there being no tuition fees. Therefore, there are other examples of ways to make progress in this policy area.

Under the SNP Government, NHS staff numbers have increased by more than 10,000, and the party is committed to supporting the development of a quality health service that will meet the needs of the Scottish people, not just now, but in the future. Workforce projections show that more than 1,000 extra NHS staff are expected to be recruited across Scotland this year. There has been an 8.4% increase in NHS staffing, to a record high. There are more qualified nurses and midwives per 1,000 of population in Scotland than there are in England and Wales. In the past year, Scotland has seen the total number of nursing and midwifery staff increase by more than 500 whole-time equivalents, with boards projecting an increase of more than 600 whole-time equivalents in this financial year. The number of doctors has increased by 26.7% or by 2,560 whole-time equivalents, and the number of consultants is now at a record high, having increased by 40.3%. Every newly qualified nurse is guaranteed one year of employment once they complete their studies—that commitment is not offered anywhere else in the UK. Our health Minister, Shona Robison, has also confirmed that the nursing and midwifery student bursary and allowance will be protected at existing levels in 2016-17. A review of the scheme is due to report in June 2016.

The NHS is a crucial public service, and the UK Government cannot continue to railroad their way through it. They are making significant changes and although reform may be needed to address current issues within the service, such decisions should not be made hastily and without full consideration of their impact and of potential workable alternatives. We have heard about some workable alternatives today. I therefore urge the Minister to commit to having a comprehensive consultation on the full proposals, to determine the best way to support and invest in this service and its students. This is a vital workforce, whom we depend on in our times of crisis. It is only right therefore that they should be able to depend on us during their training and when they hope to help the NHS in the future.

[Several hon. Members rose—]

--- Later in debate ---

[Mr Peter Lilley (Hitchin and Harpenden) (Con)]

It is a pleasure to follow on from the hon. Member for Ilford North (Wes Streeting), who made a thoughtful speech and highlighted an important point about the different study load of those training to be nurses, compared with some of us when we were at university. I do not think that that invalidates the Government’s proposals, but it is an important point to take into account.

Like the hon. Gentleman, I congratulate the Opposition spokesman on calling the debate, which has been an important one, and I congratulate the Minister on a characteristically thoughtful, reasonable and lucid response to it. I cannot help observing that the debate demonstrates the value of having people in this House who come from genuine professions, rather than having reached here purely as a result of being political professionals. There has been considerable input from those who have studied, worked or been in the national health service.

Although it is an Opposition debate, there are some points that we can all agree on. First, we should agree that we need to recruit, train and retain enough nurses to staff our health service to meet the needs of the British people. Secondly, we can agree that it is wrong—morally wrong—to rely on recruiting nurses from poor countries, who have had to bear the cost of their training, to meet our failure to train enough nurses ourselves. Thirdly, we should not be turning away British people who want to train as nurses when we need more nurses. Surely all of us can agree on those three points. We can debate how best we finance the recruitment, retention and motivation of sufficient nurses in this country, but we should all agree that that is the objective.

My initial interest in this topic came a couple of decades ago and resulted from my first career as a development economist working in Africa and Asia. I discovered while I was in the House that we were denuding Africa of nurses. We had recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country. That could not be right. I lobbied against it and the then Prime Minister promised that there would be no active recruitment from Africa, but seven years later I discovered that we had recruited another 60,000 nurses. We were continuing to recruit at several thousand a year, but we were promised that that would cease.

What I blame myself for is that it took me so long to realise that the problem did not lie so much in recruiting from Africa and other poor parts of the world as in our failure in this country to train enough nurses of our own. I did not ask why we were not doing so until I was talking to people in my local NHS, who told me that they were recruiting abroad, mainly in southern Europe but also in Asia, and they were doing so despite the fact that they would have preferred to recruit and employ nurses from the University of Hertfordshire, whom they described as excellent, well trained and in every way desirable. I asked why they did not recruit more, but they said that they could not recruit enough. Even if they recruited the next several years’ worth of output, that would not meet the needs of Hertfordshire’s health service, which is why they were recruiting abroad.

[Dr Lisa Cameron]

Does the right hon. Gentleman agree that it is ironic that through our international aid programmes we are assisting developing countries to pay for trainee placements in clinical establishments such as hospitals abroad, yet we do not afford the same rights to our NHS trainees here?

[Mr Lilley]

It is certainly bizarre that we pay African countries to train nurses and promptly recruit them to come here, so we are getting them cheaply trained abroad. I do not mind particularly the manner in which their training is financed.

The problem faced by my local NHS was that it could not get enough nurses from the University of Hertfordshire. I spoke to the University of Hertfordshire, which said that there was no lack of applicants—it turned away three quarters of applicants to its highly regarded nursing courses—but it was not allowed to expand. It had taken me decades in this House to realise that we had a system that limited the number of people we were recruiting. I duly lobbied the Government, and it may be because of my lobbying that we now have this proposal for bursaries, though I suspect the Government reached the decision on their own evidence.

The sad truth is that successive Ministers of all parties—we should recognise that—have bucked the question of how we train enough people in this country. Ministers tend to have a time horizon of roughly the time it takes to train a nurse, so why put up with diverting resources into training when the output of extra nurses will come after they have ceased to be Health Ministers? I am glad that this Secretary of State for Health and his fellow Ministers have addressed the question. However, we should recognise that it is symptomatic of a wider problem across British business in both the private and the public sector that we have a culture that does not put enough emphasis on training. It is particularly bizarre that we allow unlimited numbers of people in universities to study art history and media studies—very valuable subjects—but restrict the numbers who can train to be nurses, when we know we have a crying and desperate need for more.

I am agnostic about the best way to finance the training of more nursing recruits. Clearly, if nurses bear the extra cost, that will have to be reflected in some way in their remuneration. The Minister told us that they will actually be no worse off, so I suppose the assumption is that they will not have to repay much of their loans. It is a somewhat artificial feature of the public finance rules, but it is a feature of them, that perhaps the only way of not borrowing the money from the public ourselves is for the nurses to borrow it and for us then to write off their loans. However, whatever the financial system—the end of bursaries and their replacement with loans is probably the only option—we have to pay nurses enough in the long run to recruit, retain and motivate them.

There is one other issue we should look at before we close the debate. There are 200,000 trained nurses who maintain themselves on the register at their own expense, but who are not currently working in the NHS or elsewhere—they may be taking time off to raise a family, and they may be thinking about coming back some time. We must be much more flexible and creative about providing patterns of work that meet the family needs of those trained, valuable, caring and experienced people if we are to bring them back into the health service. That, too, will help to meet the needs of the health service, as the Government are trying to, sensibly and wisely, in the measures they have brought before us to replace bursaries with loans.

World Autism Awareness Week

Lisa Cameron Excerpts

Thursday 28th April 2016 Commons Chamber

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

I congratulate the Backbench Business Committee on granting this debate, and the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing it and on being an autism champion. As a clinical psychologist I have worked with many people who have autistic spectrum disorder. I put on the record that it is a privilege to be a member of the all-party parliamentary group on autism and to be a co-sponsor of the debate.

Autistic spectrum disorder is a pervasive lifelong developmental disorder that affects people’s social interactions. It impacts on how people communicate with others, how they relate to people and how they experience the world around them. Being a professional is one thing, but the key lesson we must learn is that the greatest insights come from those who have autistic spectrum disorder and their families. We must listen very carefully to what they tell us.

We know that how we interact with individuals with ASD and their families can have a huge impact on their quality of life. Negative public reactions can encourage people and their families to avoid situations and social contact, leading to their becoming socially isolated and experiencing mental health difficulties.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The debate has covered a lot of the structural and supportive things that need to be done, but does it not also throw down the gauntlet to us about the need to change our view? We think of people with autism as finding it difficult to see the world as we see it. We actually need to see the world as they see it.

[Dr Cameron]

As usual, my hon. Friend makes an excellent point. We must focus not on the difficulties faced by those with autistic spectrum disorders but on their full potential, and we should have greater awareness of the world as they view it.

Research indicates that 66% of autistic people, and 68% of their families, have reported feeling socially isolated, and 70% of autistic individuals are reported to have mental health disorders such as anxiety or depression. Autistic adults have been reported to be nine times more likely to die from suicide. There is a clear need to address comorbidity, and particularly mental health difficulties.

One constituent who contacted me advised that the “Too Much Information” video and campaign, which must be commended, had resonated with her. Her eight-year-old daughter has autism, and she shared with me some of her personal experiences. Her daughter is extremely vulnerable and sensitive to everyday sights, sounds, touches and smells, which cause her anxiety, panic or obsessive worries and despair. She cannot cope with changes to her environment, and she is prone to becoming distressed in public. As a result, she has experienced negative community responses, including from school peers. Her reaction has been reluctance to go back to school, and withdrawal from her extracurricular activities. Sadly, that means that she is at risk of becoming further isolated, and it is clear from this story—such stories were common among those who contacted me—that we all need to do more in many areas.

I recently attended Milton Primary School in my constituency, where the lack of understanding about pupils with autism among peers and their parents was highlighted to me. The headteacher is now engaged in good work to increase understanding through planned awareness sessions, and I commend her on that fantastic local development. Again, that highlights how teacher training and awareness in schools is key.

As has been mentioned, we must raise awareness and understanding among employers to help support people with autism into employment. Having a job is about earning a living, but it also contributes to psychological wellbeing. It can provide people with a sense of belonging and purpose, and build confidence and self-esteem. The autism employment gap is even bigger than the general disability employment gap, and only 15% of autistic adults in the UK are in full-time work. The Association of Graduate Careers Advisory Services has reported that 26% of graduates on the autistic spectrum are unemployed. Mainstream employment programmes currently on offer are failing to capitalise on the potential of those with autism. I urge the Minister to ensure appropriate support for people with autism, and for that to be covered by proposals in the disability and employment White Paper.

In 2011 the SNP Scottish Government launched the Scottish strategy for autism, and declared that autism is a national priority. That strategy attempts to improve diagnosis and assessment, and to create consistent service standards. It also helped to establish one-stop shops. We must continue to support that issue, and I offer my full co-operation and involvement with my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows) to save our local one-stop shop.

We must all be champions of autism, and I ask the Minister to support an awareness campaign, promote training for teachers and local authority staff, tackle issues raised in the White Paper, ensure that more clinicians are trained, and consider waiting time guidelines. Society must not continue to fail people with autistic spectrum disorder, so let us do all that we can together to ensure that we succeed.