Oral Answers to Questions

Debate between Lisa Cameron and Chloe Smith

Wednesday 3rd May 2023 Commons Chamber

[The Secretary of State for Science, Innovation and Technology (Chloe Smith)]

For its first three months, the Department for Science, Innovation and Technology has been harnessing the power of transformative science to grow a more innovative economy, with stronger businesses, better jobs and better lives for the British people. We have touched on AI and Pioneer. I can add that our £2.5 billion strategy for quantum tech will unlock its vast potential to the benefit of the British people.

[Dr Cameron]

As chair of the all-party group on crypto and digital assets, I have been hearing about the potential of blockchain technology for jobs of the future. It is important that these jobs are inclusive, so how will the Secretary of State ensure that people with disabilities, veterans and women have opportunities such as those to achieve their full potential?

[Chloe Smith]

I am delighted that the hon. Lady asked that question because, as she knows, I share her deep interest in the labour market and accessibility. I thank her for the work that her all-party group has done on the issue. This Government’s digital inclusion strategy has four principles: access; skills; motivation; and trust. They hold firm for blockchain and other technologies to ensure that no one is left behind.

Social Mobility Index

Debate between Lisa Cameron and Chloe Smith

Tuesday 9th February 2016 Westminster Hall

[Chloe Smith]

Thank you; that is very helpful.

I am not in the business today of doing my constituency and my city down. Indeed, only last week Norwich was named the happiest place to work in the United Kingdom. In 2014, it was voted the happiest place for children, thanks to a combination of open spaces, public amenities, safe roads and other factors. It is a great city. We from Norwich proudly call it “the fine city”, and you cannot beat Norfolk pride itself. Admiral Lord Nelson told us:

“I am a Norfolk man and I glory in being so.”

In fact, Nelson himself is arguably a fine example of social mobility. Born in rural Norfolk, the son of a vicar, to a family of modest means, he lost his mother when he was young and was only average at school. He took an apprenticeship, had the benefit of leadership mentoring and rose to lead the Royal Navy and be seen as one of the greatest Britons of all time.

Then there is Thomas Paine, radical and revolutionary, who wrote the best-selling work of the 18th century and helped to found America—not bad if anyone expects low aspiration from the son of a Norfolk manufacturer of ladies’ underwear. There is the fact that we invented the office of Prime Minister in Robert Walpole, and then there is the first woman writer in English, Julian of Norwich. From my reading of her stuff, she may well have been mad, but none the less she went and did it. Indeed, the first Act of Parliament held in the parliamentary archives—from 1497, no less—is about Norfolk apprentices.

However much I love my city and my county and want to talk it up, it is wrong to ignore important and serious research when it is presented. The Social Mobility and Child Poverty Commission recently produced its social mobility index, which shows that children growing up in the Norwich City Council area have some of the worst life chances in England. If Nelson said that

“England expects that every man will do his duty”,

Norwich children should now expect us to do our duty and put that right.

The commission’s analysis uses data about educational attainment from the early years through to further education and higher education and potential for people to be not in education, employment or training. It also includes adult prospects such as jobs, housing and pay. In simple terms, the report compares the chances for children across the country from poorer backgrounds in doing well at school, finding a good job and having a decent standard of living.

We also know, separate to the report, that Norwich has more children defined as being in poverty than the national average—in my constituency, around one in five. The commission that produced the report is sponsored by the Department for Education, the Department for Work and Pensions and the Cabinet Office. I am grateful to the Minister for being here today, and I am sure he agrees that there is plenty of work to do in the Government across Departments on this issue. There is also work for us in Parliament on any Bench to do to improve children’s life chances. Responsibility also, quite rightly, lies locally. The report is about the boundaries of Norwich City Council, and I hope that the council takes it as seriously as I do. We need to work together to improve Norwich children’s prospects.

The report also goes deep into educational data, and sadly—for that reason at least—it comes as little surprise, in the sense that the county council’s children’s services department has been improving from inadequacy for some time. A 2015 peer review of the council’s performance towards those not in education, employment or training found the overall impression that there were passionate and committed staff within the authority but no overall coherent political and strategic leadership commitment to the young people of Norfolk.

Let us look at what is in the report. The first half looks at the educational attainment of those from poorer backgrounds in each local area. I think we can all agree that background is one of the most important drivers of a child’s life chances. Under that heading, we start with early years provision. There is clear evidence that children from poorer backgrounds perform worse than their more affluent peers during the early years. For many children, that translates into worse outcomes as they go through their schooling. A Government-commissioned study of 2010 found that by school age, children who arrive in the bottom range of ability tend to stay there. The indicators in the report for that life stage are the proportion of nursery provision in the local area that is rated good or outstanding, and the proportion of five-year-olds eligible for free school meals who achieve a good level of development at the end of the stage.

I have been arguing for some time that we need more childcare provision in north Norwich in particular, where there is a shortage already. That is before parents become rightly keen to take up the 30 hours of provision that we will fund from 2017 and parents of the most disadvantaged two-year-olds make use of their entitlement. Let us ensure that that provision is of the highest quality.

I turn to the school years. There are a number of indicators in the report that determine how children who have free school meals do at primary and secondary school and then at key stages of achievement. The Norwich City Council area, I am sad to say, comes in as the 14th worst in the country in this section. It will be no secret to those who follow the issue that Norfolk has consistently performed below the national average when it comes to all students—not just the poorest—achieving the gold standard of five GCSEs. Indeed, in 2014 Norwich was the worst city in England for GCSE results.

I want every school in Norwich to be rated good or outstanding, and I would like to hear more from the Minister today about the Government’s part in that. I know that the local education authority and local academies are applying themselves to that question, too, for the thousands of students in Norwich who are being let down. I also want local leaders in schools to continue to use pupil premium money in the most imaginative and ambitious ways possible, to help the poorest students break out.

The report goes on to assess the years following school—in other words, a youth measure. As the report says, those years are crucial to social mobility, for two reasons. First, that is likely to be the first time that a young person will make a key choice about their own life and, secondly, what a young person has achieved at that point in their life has a significant impact on their chances as an adult, so it is important to be on the right track during that period.

The Norwich City Council area chips in as the 17th worst in the country in that section. The point about young people being able to go into work and make their own choices is precisely why I have worked so hard with many others locally to help young people into work through the Norwich for Jobs project, which I founded and which has helped to halve our city’s youth unemployment, but there is clearly much more to do. I would like to hear from the Minister how the Earn or Learn taskforce is addressing the problem and what else officials in Jobcentre Plus and other Departments are doing to help young people to make good and ambitious choices that suit them.

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

The hon. Lady is making a compelling speech. Does she agree that this is about not just getting young people into jobs, but affording young people with potential the ability to start their own business and providing support in that regard?

[Chloe Smith]

The hon. Lady has anticipated one of the next things that I was going to say. She is absolutely right, and for the record I will add that this section of the report—I am sure that hon. Members have read it themselves—is also about further and higher education, so we should talk about a range of options and opportunities at this point.

The second half of the report looks at the outcomes achieved by adults in the area, and this is where employment, and the types of job and pay come in.

Mental Health

Debate between Lisa Cameron and Chloe Smith

Wednesday 9th December 2015 Commons Chamber

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

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it.

I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.

The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.

Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.

When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.

In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.

Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.

I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.

I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.

Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.

I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling 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 suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.

Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.

[Chloe Smith (Norwich North) (Con)]

I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?

[Dr Cameron]

I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.

Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.