Government Action on Suicide Prevention

Liz Twist Excerpts

Wednesday 8th June 2022 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I thank my hon. Friend the Member for Bristol East (Kerry McCarthy) for securing this enormously important debate, and for her excellent introduction to it.

The first thing I want to say is that, according to the most recent figures we have, 4,912 deaths by suicide were registered in 2020 in England alone. Men aged 45 to 49 are at greatest risk of death by suicide, and sadly for me, the north-east region is the area with the highest suicide rate, at 13.3 per 100,000. I am certainly unhappy about that and I am working with people locally to address the issue.

Some of the issues I want to touch on have already been covered, such as the refreshed national suicide prevention plan. This is hugely important, and something I have raised with Ministers before, as the Minister is aware. The consultation is welcome, but I agree with my hon. Friend the Member for Bristol East that we must make sure that suicide is properly addressed within it. It is enormously important that we have that dedicated attention and drive forward innovation in this area.

We also have to talk about funding for suicide prevention services. The NHS long-term plan allocated £57 million for suicide prevention and bereavement services, which are hugely important to local areas, but £25 million of that funding only ran until 2021, and all funding supporting local areas will cease in 2023-24. We need renewed ringfenced funding, which is also something I have raised as chair of the all-party parliamentary group on suicide and self-harm prevention. I know from speaking to my local services, both NHS and public health, how important it is that the funding is there to continue that collaboration and detailed work at local level.

Another thing I want to touch on is the situation for middle-aged men—one of the highest-risk groups. Suicide is the leading cause of death among men under 50 in the UK, and men account for three quarters of all suicides. As I have said, men aged 45 to 49 are most at risk; rates among this group have been persistently high for many years. Men who are less well off and live in the most deprived areas are up to 10 times more likely to die by suicide than more well-off men from the most affluent areas.

I am grateful to the Samaritans, who provide the secretariat to the APPG, for telling me about some in- depth research they have done with less well-off middle-aged men who have been struggling with their mental health, including having suicidal thoughts over a period of time. The themes those men told the Samaritans about included a lack of many meaningful social connections, often throughout their life, and having relationships connected to substance abuse. The other main theme was financial instability, which could include an erratic work history or long-term unemployment. There is no getting away from the fact that socioeconomic factors—deprivation, unemployment and other issues—have a real impact on the figures. It is really important to recognise those issues and work with colleagues in other Departments on them.

The Samaritans are calling for a focus on early intervention and support through the full range of statutory services that men may be in touch with. Research suggests that nine out of 10 middle-aged men who died by suicide in 2017 had been in contact with at least one frontline service or agency a week prior to their death. We also need further investment in voluntary sector and community provision to provide the services and initiatives that middle-aged men often find helpful in building connections and having conversations.

The other group that I want to refer to is people who self-harm. The all-party group conducted an inquiry into self-harm in younger people. We know that not all people who self-harm proceed to suicidal ideation or completing suicide, but there is a clear link. We need to ensure that people have readily available access to support at an early stage, because self-harm is such a strong risk factor for suicide.

In that inquiry, many people told us that they were considered too high-risk for primary mental health services, but not ill enough for secondary health services such as community mental health teams, or CAMHS in the case of younger people. We need to increase capacity and build expertise within talking therapy services to support people who self-harm, allow self-harm to be discussed in a safe, supportive way, and carry out assessments of people who disclose self-harm. We should get away from the stigma, because it still happens that, when people self-harm, they are thought to be attention-seeking. Instead, we need to ensure that it is picked up as a possible sign of a path. Preventive issues are also key. Having access to the appropriate services quickly is really important, so that people can get support.

On inequality and levelling up, I mentioned that people in disadvantaged communities faced the highest risk of dying by suicide, and that financial instability and poverty could increase suicide risk. Insecure income, unmanageable debt, unemployment and poor housing conditions all contribute to higher suicide rates, so we really need a cross-Government approach that recognises those risk factors and does something to address them. Specific actions would be to prioritise in the plan tackling inequalities as suicide risks across Government policy interventions, including through employment support, social security and economic planning. We should ensure that money advice and financial support is consistently available to everyone. We should better utilise what the Samaritans call the touchpoints of the state, such as work coaches in jobcentres and others that people come in contact with.

My hon. Friend the Member for Bristol East mentioned the need for real-time suicide data. That is being developed, and it is absolutely essential. We cannot continue with the system of waiting for the coroner’s inquest to decide the cause of death. We need to know, so that we can highlight issues early and respond.

On the Online Safety Bill, which I have raised previously with Ministers, it is important that health takes a leading role to ensure that people do not have easier access to sites that promote self-harm or suicidal plans. There need to be new offences, and suicide and self-harm content needs to be addressed.

On alcohol use and suicide, I am sure others will speak in more detail, but we had a quotation from a Samaritans survey respondent:

“My hope is that professionals start to see that alcohol use is often the result of an underlying issue and not simply tell people to sober up without offering further support for how to deal with the root cause”

of the problem. We need integrated commissioning and provision of mental health and alcohol treatment services, training for all healthcare staff around the relationship between alcohol and suicide, and further funding for local drug and alcohol recovery and treatment services, many of which have seen huge cuts in the last 10 years.

Finally, suicide is preventable, not inevitable. It is important that we take real steps to ensure that we prevent unnecessary deaths and have real plans in place to make that happen.

North East Ambulance Service

Liz Twist Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

A statutory duty of candour is in place. As I said, if a mistake happens—mistakes can always happen, even with the best prevention methods in the world—there is a statutory duty to reveal it to the family and the patient involved, and to have a full investigation and learn lessons from it. I am concerned that that may not have happened in this case.

[Liz Twist (Blaydon) (Lab)]

The reports in The Sunday Times yesterday on what has happened with the North East Ambulance Service and the cover-ups were truly shocking. My thoughts, and I am sure those of everyone, are with the families who have found out information that had previously been covered up. The Minister talks about the steps the Government have taken to ensure that whistleblowers can come forward, but clearly something has not worked. Equally, the CQC also missed it. What more steps will the Government take to pursue the investigation to ensure that this simply cannot happen again?

Smokefree 2030

Liz Twist Excerpts

Tuesday 26th April 2022 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under you as Chair, Ms Nokes. I commend the hon. Member for Harrow East (Bob Blackman) and my hon. Friend the Member for City of Durham (Mary Kelly Foy) for securing today’s debate. I also wish the hon. Member for Harrow East a very happy birthday.

Smoking, as we have heard, is not a lifestyle choice. It is a lethal addiction entered into by the vast majority of smokers even before they reach adulthood. It is an addiction that is increasingly concentrated among the most disadvantaged in society, fuelled by an industry—the tobacco industry—whose behaviour must be stringently regulated if we are to achieve our smokefree 2030 ambition.

Like my hon. Friend the Member for City of Durham, my constituency of Blaydon falls under Gateshead Council in the north-east, which I regret to say is the most disadvantaged region in the country. Smoking rates in Gateshead are particularly high, bringing disease, death and disability disproportionately to my constituency. In 2019, more than 17% of adults in Gateshead smoked, compared with 15.3% for the north-east as a whole, and far higher than the average for England of 13.9%.

That higher rate of smoking translates to a lower average life expectancy. The average male life expectancy in Gateshead is eight years less than in Westminster, and five years less for women. Smoking costs the NHS in Gateshead £9.3 million, and £5.6 million to local authorities for social care costs that are entirely due to smoking and entirely preventable. Tobacco addiction has been levelling down communities across the country for decades, and will go on doing so until the Government decide to get serious about delivering the smokefree ambition—for all in society.

Smokers in Gateshead spend on average £2,000 a year on smoking. The total spend in Gateshead is £54 million, an eye-watering amount of money that goes up in smoke for no benefit to the local community. Ending smoking will significantly increase disposable income in poorer communities such as those across Gateshead, helping to grow the local economy and to improve health and wellbeing for tens of thousands of people.

In March, I was pleased to be able to attend the event in Parliament marking national No Smoking Day and to reflect on the progress that has been made in tackling smoking over the years. Also, however, the event looked at what more needs to be done. The Minister spoke passionately about the Government’s commitment to making England smokefree by 2030, and said that investment in stop smoking services would be at the heart of the forthcoming tobacco control plan.

I agree wholeheartedly. Smokers need to be motivated and supported to quit. However, the funding for stop smoking services has been cut by a third in real terms since 2015. That funding must be reinstated if the services are to play their vital role in delivering the smokefree 2030 ambition.

That is not the only area that needs extra funding to achieve a smokefree 2030. Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. The Government’s ambition is to reduce smoking in pregnancy to 6% by 2022, but with rates at 9.6% in 2020-21, that is unlikely to be delivered.

The rate of decline in smoking during pregnancy has been higher in the north-east, and that is because we have invested in specialist interventions. We are delighted to see that initiative being rolled out across the country as part of the NHS long-term plan. Smoking during pregnancy rates remain too high, however, so the north-east has gone further by introducing voucher schemes to provide a financial incentive to pregnant smokers to quit. That is particularly powerful for women on low incomes. In South Tyneside, an area of high deprivation, the proportion of pregnant women who are recorded as being smokers at their time of delivery has dropped by a third in the three years since the scheme was put in place.

Maternal smoking cost the NHS £20 million in 2015-16, with more than 10,000 episodes of admitted patient care. Since smoking is so damaging, incentive schemes are cost-saving, with an estimated return on investment of £4 for every £1 invested. Implementing financial incentives at scale is a vital measure that needs to be part of the forthcoming tobacco control plan, which I hope to see included in the independent review—but it will need funding.

I will touch briefly on mental health. Much more investment is needed to tackle smoking among those with a mental health condition. As many as one in three smokers have a diagnosable mental health condition. The NHS long-term plan tobacco dependency treatment pathway presents a major opportunity to tackle smoking among those with serious mental illness, but many others are not in that category. We need to ensure that much more work is done on pilot projects for IAPT—improving access to psychological therapies—counselling. Counsellors are willing to deliver such support, and they should be given the opportunity to do so.

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[Maggie Throup]

I think the hon. Gentleman must have read the next page of my speech, because I was about to come on to that. He makes a really important point. As has been mentioned by the hon. Gentleman, my hon. Friend the Member for Harrow East and the hon. Member for East Londonderry (Mr Campbell), who is no longer in his place, smoking rates are far higher in poorer areas of the country, among those socioeconomic groups. We see smoking rates of 20% in more deprived areas, compared with 5% in wealthier areas, and nearly one in 10 pregnant women still smokes, which increases the risk of health problems for their baby. Smoking prevalence for people with long-term mental health conditions is over 25%, so the burden of tobacco harm is not shared equally.

We cannot let that continue, so the Government are committed to doing more. Over the past decade we have made significant steps towards making England smokefree—a bold and ambitious target that we committed to in 2019. We continue to enforce high taxation to reduce the affordability of tobacco. As part of the annual Budget process, Her Majesty’s Treasury will continue the policy of using tax to raise revenues and will encourage cessation by continuing with duty increases on tobacco products above the retail prices index. We continue to invest in local stop smoking services and our high-impact marketing campaigns such as Stoptober—I hear it is VApril this month.

Between 2010 and 2021, almost 5 million people set a quit date with stop smoking services, and 2.5 million reported quitting after four weeks. We continue to enforce a strong regulatory framework, and we have introduced policies such as smokefree legislation and standardised packaging. All these measures, and many more, have been instrumental in helping smokers to quit and protecting future generations from starting this lethal habit.

[Liz Twist]

The Minister has spoken about the great progress that has been made in 11 years, but is it not about time that we started expecting the people who caused this problem to pay for the cost of further tobacco control measures and getting people off smoking? Is it not about time that the “polluter pays” principle is adopted?

[Maggie Throup]

If I may, I will come to that later in my speech, but the hon. Lady makes a very good point.

On top of the measures, the NHS has renewed its commitment to tobacco treatment through the NHS long-term plan, delivering NHS-funded tobacco treatment services to all in-patients, pregnant women and people accessing long-term mental health and learning disability services until 2024. The Government also continue to explore ways to move smokers away from smoking and towards alternative nicotine products such as vapes, as highlighted by the hon. Member for North Tyneside (Mary Glindon). We know that the best thing a smoker can do for their health is to quit smoking altogether, but we also know how hard that can be. It remains the Government’s goal to maximise the public health opportunities presented by vapes while ensuring that such products are not appealing to young people and non-smokers. The hon. Member for Denton and Reddish made a very good point on this issue in his speech, and it requires balanced and proportionate regulation.

Despite the progress made so far, the Government acknowledge that we need to go further to achieve our ambition to be smokefree by 2030, which is why the Secretary of State for Health and Social Care asked Javed Khan OBE to lead an independent review into tobacco control in January this year. The Khan review is expected to be published next month and will make a set of recommendations to the Government. The review has two objectives. The first is to identify the most impactful interventions to reduce the uptake of smoking, particularly among young people. The second is to identify how best to support smokers to quit, especially in deprived communities and among priority groups.

Mr Khan has met hon. Members from both the all-party parliamentary group on smoking and health and the all-party parliamentary group for vaping, and he has carefully considered their views and proposals. Quite a number of members of those APPGs have expressed their approval of that route and how Javed Khan is getting into the depth of everything. Once the review is published next month, the Government will consider its recommendations, which will help inform both the upcoming health disparities White Paper and the new tobacco control plan, to be published later this year.

Health and Care Bill

Liz Twist Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with. I know that my hon. Friend will continue to press that point and I pay tribute to him for being the policy Minister at the time and for making huge progress on this agenda. I suspect that we will return to this matter subsequently, and I look forward to the comments of the shadow Minister, the hon. Member for Tooting, in due course.

[Liz Twist (Blaydon) (Lab)]

Will the Minister give way?

[Edward Argar]

I will not now, but I may during my wind-up speech, if I have time. I want to conclude my remarks so that colleagues can make their contributions on the matters that I have referred to, but if there is time, I commit to taking an intervention from the hon. Lady at the end of our consideration of this set of Lords amendments.

We come, finally, to Lords amendment 92 and the amendment offered in lieu relating to abortion. I am aware of strong and sincerely and genuinely held views from Members on all sides of this debate and this issue, and I respect the integrity of their views. Although I will set out why the Government took the action that they did and the procedure that is in place, I emphasise at the outset that, given that this matter is before the House because of an amendment by their lordships, it is right that this is properly considered and that this will be—in line with how we normally treat these matters—a free vote, in which how individual Members vote will be a matter of conscience.

In response to the covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home. That temporary measure addressed a specific and acute medical need, reducing the risk of covid-19 transmission and ensuring continued access to abortion services. My right hon. Friend the Secretary of State announced last month that the approval will end at midnight on 29 August 2022.

--- Later in debate ---

[Edward Argar]

Given that I spoke at length in my opening remarks, I will endeavour to use the few minutes remaining to me to cover some of the key points made in the debate. First, I should have said in my opening remarks, and say now to the hon. Member for Linlithgow and East Falkirk (Martyn Day), that I am grateful to the devolved Administrations for the constructive manner in which they have engaged with me and with my Department. I hope that that process has been collegiate and satisfactory from their perspective as well.

Let me clarify my response to a point made by the hon. Member for Gower (Tonia Antoniazzi). Health is, of course, devolved in Wales and Scotland. Were the Government’s amendment in lieu in respect of abortion to be passed, it would apply to England and Wales, but it would simply do what the Welsh Government are already doing.

We have called for Members to reject Lords amendments 85 to 88, in respect of tobacco. We heard from the hon. Member for Stockton North (Alex Cunningham), who rightly cited the hon. Member for City of Durham (Mary Kelly Foy). I am sorry that she could not be here today, but in Committee she took a close and well-informed interest in these issues. We have also just heard from my hon. Friend the Member for Harrow East (Bob Blackman).

[Liz Twist]

Will the Minister give way?

[Edward Argar]

I did promise not to take interventions, given the time, but I will take one from the hon. Lady, because I was not able to do so during my opening remarks.

[Liz Twist]

May I add my backing to the call for support for Lords amendment 85? Yesterday many of us attended a reception organised by Cancer Research UK, which has highlighted this issue. Will the Government please bite the bullet and support the amendment?

[Edward Argar]

Before responding to the hon. Lady, I must correct myself. I should have said “With the leave of the House” before starting my wind-up remarks.

I am grateful to the hon. Lady for her work on this issue. Although this does not normally fall within my ministerial portfolio, she and I have debated this issue across the Floor of the House, and I know her interest and her passion for this issue, and the hard work that she has done on it. While I recognise that, I believe that the Government’s approach of resisting the Lords amendments in this space is the correct one, and I therefore fear I may disappoint her. We will see whether the House divides on this matter; I suspect it will, but that will be up to shadow Ministers and other Members. I welcome the debate, and I suspect it is a debate we will continue to have.

I have listened extremely carefully to my hon. Friend the Member for Buckingham (Greg Smith), as he would expect. I would encourage him not to press the point further at this stage, and I will of course continue to reflect carefully on the points he has made. They are important points about the impact on industry and on the broadcasting industry, and I will consider carefully what he said, but we believe that we have struck the appropriate balance in the legislation as it stands. I am grateful to him for his intervention in this debate and his comments.

It was perhaps predictable when looking at the nature of the amendments in this group that Lords amendment 92 and amendment (a) in lieu would inform the bulk of the contributions across the House. This is an issue that Members quite rightly hold strong views on, and there are sincerely held and informed views on both sides of the debate. It is important that this debate is well informed. We heard from my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer), for Congleton (Fiona Bruce) and for Sleaford and North Hykeham (Dr Johnson), and the hon. Member for Strangford (Jim Shannon), the right hon. Member for Kingston upon Hull North (Dame Diana Johnson) and the hon. Member for Birmingham, Yardley (Jess Phillips). May I offer my condolences to the hon. Member for Birmingham, Yardley and her family on the loss of her mother-in-law, Diana, on Friday?

We also heard from my right hon. Friend the Member for Basingstoke (Mrs Miller), my hon. Friend the Member for Sevenoaks (Laura Trott) and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), as well as from my hon. Friend the Member for Boston and Skegness (Matt Warman), who gave a typically powerful speech on the subject. We also heard from the hon. Member for Upper Bann (Carla Lockhart).

I have made it clear throughout the debate that this is a free vote, but I would urge Members, in reaching their decisions, to be cautious about some of the figures that have been used in support of some of the arguments today. We do not have all the detailed figures, and I understand that some of them may be based upon extrapolations from freedom of information requests conducted in this respect. I am not drawing any conclusions beyond that, but I would urge caution among Members in how they use those figures.

It is absolutely right that this issue, having been inserted into the Bill by the noble Baroness Sugg, should have been carefully considered by this House. The volume of contributions reflects the importance attached to it by Members. The Government have been clear that these were temporary provisions put in place to reflect an extraordinary set of circumstances, and my right hon. Friend the Secretary of State has been clear that, as we move out of the pandemic, such temporary pandemic-related measures should cease. However, the House has had the opportunity to debate this matter today, and the views expressed on both sides are important for the House to hear.

As I have said, I hope that Members will be clear about the process that we will follow. We hope that, on the voices, the House will reject the Lords amendment tabled in Baroness Sugg’s name purely on the basis that it is legally defective and will not do the job that was intended for it in policy terms by the noble Baroness. We have therefore tabled what we believe is a legally effective amendment in lieu of that amendment. Uncertainty in this area of policy and of law does no one any favours, and we would not wish uncertainty for anyone in this space. That is why we were unable to accept the noble Baroness’s amendment and why we are asking the House to reject it, but we have come up with something that we believe provides clarity and is legally effective in what it does. As I say, it is for hon. Members to consider their own position on this matter of conscience, which is of import to our constituents up and down the country, and I suspect they, too, will have strong views either in favour or against. It is right that the House brings such matters to a debate and a vote.

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[Edward Argar]

I will address the care cap, because there is a fair bit to say. I was just addressing the noble Lord Lansley’s amendment. I apologise for missing the hon. Lady’s first point. We do not think it is necessary to have health inequalities explicitly among the triple aims, as we believe that the issue runs through everything that ICBs do and everything the Bill sets out. We therefore feel that the Bill is effective, and that each ICB’s ICS will have regard to health inequalities and will see them as central to its objectives.

Before I turn to Lords amendment 80, I will briefly address Lords amendment 51, which relates to consultation with carers during hospital discharge planning. We have heard about the strength of feeling in the other place on that issue. We wholly agree that we must ensure that, where appropriate, unpaid carers are involved in planning around discharge. Although the Government appreciate the intention behind the amendment and want to address the concerns raised, we want to do so in the most effective way, and in a way that does not create unintended delays to discharge. I ask Members to support our amendment in lieu, which would achieve much of what Lords amendment 51 sought to achieve. It will introduce a new duty on trusts and foundation trusts to involve carers during adult discharge planning. Unlike schedule 3 to the Care Act 2014, this duty applies to all carers where the patient has care and support needs following discharge; and it applies to young carers as well as adults. Our amendment in lieu and the new statutory guidance will ensure that patients and carers are involved in discussions about post-discharge care as soon as they start.

[Liz Twist]

I am pleased that that concession has been made. However, a number of points of clarification would be really helpful to carers. One is about being given a choice about caring, carers having the right information, and carers being able to express their needs properly. The second is about disabled children, who are not referred to here, and the third is about ensuring that young carers are clearly covered by any guidance issued. Will the Minister say how those issues will be addressed?

--- Later in debate ---

[Liz Twist]

rose—

[Edward Argar]

I have given way to the hon. Lady already in this debate, as I did in the debate on the previous group of amendments, so I shall make a little progress. She knows that I am always tempted to give way, but I do want to make some progress.

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[Sir Charles Walker]

I congratulate the Government on their amendments on mental health. As a former Minister with responsibility for mental health, Madam Deputy Speaker, you know that I have long taken an interest in the subject, so I am delighted that parity of esteem is included in the legislation. It is a very important amendment.

Parity of esteem must mean something, however, and should not be a jumble of words. It was the case that too many voices on both sides of the House fell silent during the covid pandemic. That may have been due to the fog of war, but the scarring of that silence runs deep in the communities that we represent—there are some very ill and damaged people out there. It is fine for us to talk about parity of esteem, but we have to live it and deliver it, and I am afraid that we fell short for 18 months.

I welcome the amendment and the recommitment of hon. Members, but we were all found wanting when it counted. I have the witness statements of more than 2,000 people who suffered with mental health problems during the pandemic and who wrote to me detailing what that was like. One day, I will make those statements available to the Government and to the inquiry, but today, I just thank the Minister and my right hon. Friend the Member for Maidenhead (Mrs May), who joined me in initiating the amendments. I hope that the next time that the country and this place are challenged, we rise to it, because mental health is as important as physical health.

[Liz Twist]

It was not my intention to speak in the debate, but I need to ensure that the point that has been raised about Lords amendment 80 and the cap is not missed. The Minister talked a great deal about fairness, but how can it be fair that my constituents and people across the north-east and the north generally will face what the King’s Fund described as

“people with low levels of wealth”

being

“exposed to very high care costs”?

It cannot be right that the northern regions and other areas will face that unfairness. The Government should reconsider the issue and come forward, as other hon. Members have said, with further discussions about how to resolve it. The proposal in the Bill is very different from that originally presented to the House on care costs.

On carers, I agree with other hon. Members who have raised the issue. As I mentioned earlier, we need much more detail and certainty for those carers and we need to be able to take part to ensure that the guidance issued is effective and represents and meets their need.

Integration White Paper

Liz Twist Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend, who quite rightly never misses an opportunity to pay tribute to his local hospital trust. As he knows, I am always happy—as is my hon. Friend the Minister for Care and Mental Health—to hear any ideas for innovation that may improve outcomes for patients and communities.

[Liz Twist (Blaydon) (Lab)]

As we have heard, councils and health service bodies have been taking the opportunity to work together in the absence of Government action. In Gateshead, we have a joint commissioning director for health and care, which has worked out very well. So things have been happening without the White Paper. The key to addressing integration is the workforce. With thousands of NHS vacancies and thousands of social care vacancies, we really need to address that issue. We need a comprehensive, detailed plan on restructuring the social care workforce to ensure it is recognised as much as the NHS workforce.

[Edward Argar]

I am grateful to the hon. Lady, although I am not entirely convinced on her point about the absence of Government action. Yes, co-operation has been happening organically from the ground up, but that has been encouraged and supported by Government action—including various pots of funding, for example relating to discharge during the pandemic—driving that activity and helping to foster that culture of co-operation. She highlights the importance of the workforce and the need for increasing numbers. That is a point I have already acknowledged. I have made clear that the Government have a plan and are already delivering increases in the workforce.

Children’s Mental Health

Liz Twist Excerpts

Tuesday 8th February 2022 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

I am pleased to be able to speak in this hugely important debate.

The facts and figures speak for themselves: a 77% rise in the number of children needing specialist treatment in 2021; three quarters of children not being seen within four weeks of being referred to children’s mental health services, and there were half a million referrals in 2021 according to the Children’s Commissioner; and over a third of children with professional referrals being turned away from mental health services. There are also differences according to where people live and in which clinical commissioning group they are. This is not good enough for our children. We need to do more.

I echo my hon. Friend the Member for Batley and Spen (Kim Leadbeater), who said that, although we are looking at the impact of the pandemic, this problem predates the pandemic. Many of us have taken part in previous debates to ask for action and Government progress. Although the pandemic has certainly made things worse for children, this situation predates the pandemic, as the Minister knows. We need to make sure that there is early intervention for young people with mental health problems, with professional help, and we need to take local action as well.

I chair the all-party parliamentary group on suicide and self-harm prevention. The year before last, we did a report on self-harm in children, and some of the things we looked at were about having really local, low-level assistance that people could access for support. Organisations such as YoungMinds, the Mental Health Foundation and others have been talking about having drop-in hubs for mental health services, as indeed we are, but that intervention needs to start quite early as well.

I want to praise two schools in my constituency —Whickham School, a secondary academy, and Kingsmeadow Community School; I have visited both and talked to the young people there—for the efforts that they are making to tackle the mental health issues among the young people they teach. I commend them very much for their efforts. I would like to see, as we are proposing, very much more support in schools to tackle mental health problems.

On inequalities, we cannot but notice that not all of us are affected in the same way. If people suffer deprivation, poor housing and all those other inequalities, the chances are that they may be affected worse. It is really important that we recognise that when we are developing strategies to deal with it.

Research by the Mental Health Foundation has found that young people experienced especially high levels of loneliness during the pandemic, peaking at 69% in the final month of 2020. There are well-established links between loneliness and poor mental health, and we must take steps to address that through schools and throughout our communities. Most of all, we must make it a public health priority to tackle all these urgent mental health issues. We do not want people to develop mental ill health. We want people and our children to be well. I urge the Government to take action to redress the lack of support currently being provided.

[Several hon. Members rose—]

Cumberlege Report

Liz Twist Excerpts

Thursday 3rd February 2022 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate the right hon. Member for Elmet and Rothwell (Alec Shelbrooke) on securing this important debate, and I thank the Backbench Business Committee for making it possible. As the right hon. Gentleman said, over six months ago we debated this same issue in the main Chamber. We pushed the Government for responses on the recommendations of the Cumberlege report. Many Members spoke passionately at that debate.

Today I want to talk about sodium valproate and the impact it has had. I looked up my speech from last July in Hansard earlier, and my speech today is almost the same. Forgive me if I am repeating from Hansard, but I think it is worth restating these points while giving an update.

Sodium valproate has had an impact on so many people, including children and women who took the drug during pregnancy. I want to talk about my constituent Bethany Dodgson, a young woman affected by foetal valproate syndrome. She speaks up on this issue and does a brilliant job of making people aware of it. She is also a carer for her brother, who is more seriously affected by difficulties caused by foetal valproate syndrome, and does a brilliant job of that.

I want again to pay tribute to Janet Williams and Emma Murphy from In-FACT—the Independent Fetal Anti-Convulsant Trust—who have done so much to campaign on this issue, and to all those other women and other people who have campaigned. As I said last year, it is really scandalous that we still have children being affected by foetal valproate syndrome today because their mothers were not aware of the risk of taking sodium valproate during pregnancy. Emma and Janet have campaigned, as have other people; they have been through the records and talked to people. I am sure many of us here have talked to Janet and Emma as they have gone about their work. They have ensured that women are made aware of the risks if they are pregnant or considering pregnancy.

It is now 18 months on from the Cumberlege report, “First Do No Harm”, and what we have seen is one letter sent some months ago to warn women of the risk. There are still issues to be tackled, and Janet, Emma and others continue to work with GPs and others to ensure that there is awareness of the issue. There have been attempts in previous years, with greater or lesser success, to ensure that doctors were aware and warned their patients, but much more needs to be done actively to ensure that no more children are harmed.

I would like to talk, as others have, about the recommendations of Baroness Cumberlege’s report “First Do No Harm”. First, the Government have accepted the call for a patient safety commissioner; I know that it is in the process of being advertised and that an appointment will be made. That is significant and very helpful. There is some movement, as there was at the debate in July, but we still do not have a patient safety commissioner in place. I hope that will happen quickly. I urge the Minister and the Government to continue to act and to press for swifter action to ensure that a commissioner is in place and is effective in pursuing patient safety issues.

As I said in July, there must be a redress agency. That is one of the recommendations of the report. I am disappointed, as I know lots of the women are, that the Government have now said, “There will be no redress.” I said last July that going to the law for compensation or redress is no answer for people who have suffered from any of the syndromes we are talking about. They have already suffered enough, and going to law is further pain and torture. It is a trial on top of what they have experienced—and, in some cases, continue to experience, as do their children, daily. I ask the Government to think again about that.

I endorse what Baroness Cumberlege said in her report: there must be an independent redress agency, so that people are spared the pain of having to keep fighting in law for their rights. I hope the Government will think again, as the right hon. Member for Elmet and Rothwell said. I join him in calling for a redress scheme to be developed, even at this stage, to ensure that people do not continue to suffer and can cope with their conditions. These people have already had to live for years with the physical consequences for themselves or their family, without their views being heard. Please, Minister, think again, and take away from this debate the fact that there is cross-party support for a redress agency to compensate those people.

We heard about the patient reference group. When we spoke in June, it had been set up and was working. However, now that it has reported, there is no continuing involvement of patients in any successor group or body that would allow their voices to continue to be heard. I urge the Minister to look again at that, and to set up a patient reference group, or something with another name; the name does not matter. What matters is ensuring that the people going through this process are involved in what happens in the future. Please, Minister, look again at that. I am pleased that, since our last debate, the all-party parliamentary group first do no harm has been set up, and that Baroness Cumberlege continues to be involved and engaged on this issue, which is commendable. I know how hard she continues to work on this. However, that group was set up not by the Government, but by Members of this House and affected patients to ensure that their issues are not forgotten.

Finally, I will repeat what I said last year. Let us be clear: we are talking about a medical issue, but this is a women’s issue. It is an issue of women not being listened to and their concerns not being heard, and of action not being taken. Frankly—I will say it again—it is just not good enough. We need to ensure that their voice is heard. As we develop and consult on the women’s health strategy, which the Minister and I discussed in an Adjournment debate the other day, we need to make sure that we learn these lessons, and the lessons of so many other cases where the voices of women have not been heard and listened to effectively. The title of the Cumberlege report is, “First Do No Harm”. It is vital that this principle is looked at when we consider the women’s health strategy.

--- Later in debate ---

[Maria Caulfield]

I thank my right hon. Friend for making that point. Compensation can be claimed now. Our concern about setting up a specific body to oversee that is that that would not address the fundamental problem of why it is difficult to get compensation. However, it is a fundamental right of anyone who believes they suffered from clinical negligence to seek compensation, and we actively encourage that.

[Liz Twist]

This is really important. These people we have been talking about all afternoon are, as the right hon. Member for Hemel Hempstead (Sir Mike Penning) said, living with the consequences of those actions. Baroness Cumberlege is absolutely clear about setting up a redress agency to

“administer decisions using a non-adversarial process with determinations based on avoidable harm looking at systemic failings, rather than blaming individuals.”

Recommendation 4 is that:

“Separate schemes should be set up for each intervention…to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.”

Going to the law is not an answer for these people. It is difficult, it causes anxiety and it is expensive. We need real action now to address the problem.

--- Later in debate ---

[Maria Caulfield]

I have addressed the points about redress, which is available. We are reforming the process of clinical negligence to make it easier for patients to get compensation without the need to go to court, and we are having some success in that. There is a very different system in place now compared with when many of these ladies were affected.

The patient safety commissioner was mentioned by some colleagues. The consultation proposed details for setting up the commissioner’s role. Baroness Cumberlege is on the recruitment panel for that position and will keep a close eye on the role of the commissioner. The advert and recruitment process is now up and running, and we expect to appoint someone very soon. I reassure colleagues that that appointment will be in place: the recruitment process has started, Baroness Cumberlege is on the panel to appoint the commissioner, and that commissioner will be independent—a point made by my right hon. Friend the Member for Maidenhead—of the Department of Health and Social Care, which will of course work closely with them. The commissioner will be able to scrutinise both the NHS and the Department itself.

On recommendation 5, about specialist mesh services, eight specialist centres are now operating in England, where women who have been affected by mesh implants can access treatment and mesh removal. A ninth is being set up in Bristol at the moment. I remain very open to colleagues’ experience of those mesh services. Women have the option to choose which centre they go to, but I recognise that that might involve great distances from where they live.

If women are not being referred to the centres, however, or if their experience of the centres is that their needs are not being met, I am keen to hear about that, because the whole point of setting the centres up was to ensure help for those women who have experienced mesh implants that have caused huge trauma—I take on board everyone’s points—to them, changing their lives and that of their families forever. If that is not working, the women’s health ambassador, the patient safety commissioner and I will look at that, because that was the whole point of setting up such services.

[Liz Twist]

Will the Minister say something about the specialist centres proposed for valproate and Primodos? They do not exist; I believe that the Government rejected them.

[Maria Caulfield]

Valproate should not be being used on women or girls able to have children, unless they have a pregnancy prevention programme in place. That is to ensure that patients are fully aware, if they need to take sodium valproate, of the effect on any potential pregnancy. The NHS also commissioned the paediatric neurosciences clinical reference group to support the development of pathways for care services, specifically to improve patient support and co-ordination on the pathway for sodium valproate.

Mechanisms are therefore being set up for those women and girls who need to take sodium valproate. I think my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) pointed out that, in other settings, a huge amount of work is done to ensure that those women do not get pregnant. Also, a multidisciplinary expert group with experience in responding to exposure has been established. It will report its recommendations to NHS England in March this year. We will follow up on those recommendations, but a piece of work is being done specifically on sodium valproate, which will help to prevent such problems in the future.

Recommendation 6 was on MHRA reform. The review highlighted the need for the regulatory agency to undergo substantial revision, in particular on adverse event reporting and patient engagement. As many Members said, instances were flagged many times by many different people—the women themselves, MPs in this place, charities and other bodies—but people did not listen, although the MHRA has a duty to do so.

The MHRA has now initiated a substantial programme of work to improve how it listens and responds to patients and the public, developing a much more responsive system for adverse event reporting and supporting timely and robust decisions involving patient safety. It has been consulting on a new regime for medical devices that makes patient safety, engagement and transparency more prominent.

To strengthen its commitment to patient engagement, the MHRA recently established an enhanced customer service centre to make it easier for patients to express concerns, whether about medicine or devices that are being used. The MHRA has also appointed a chief safety officer, Dr Alison Cave, who will lead its ongoing commitment to the recommendations.

On setting up a database to collect details of all implantations of devices, which is recommendation 7, we have already legislated for that through the Medicines and Medical Devices Act 2021. The Act created a power for the Secretary of State to regulate for the establishment of a UK-wide medical device information system. Alongside developing those regulations, more than £11 million has been set aside for the work, involving partners across the healthcare system to scope, test and cost options for that workstream.

On transparency for payments, which I think was raised by the hon. Member for Chesham and Amersham (Sarah Green), who spoke about the conflicts of interest between doctors and pharmaceutical companies or providers of surgical mesh, recommendation 8a highlights the need for greater transparency for payments made to doctors. The recommendation calls for a register of doctors’ interests and for recognised and accredited specialisms to be held by the General Medical Council.

As the Government set out in our response to the review, we agree that lists of doctors’ interests should be publicly available. We continue to hold the view that that information will be most accessible to patients if it is published by healthcare providers rather than by the GMC. We are taking that measure forward and it should be in place by July this year.

We are also working with professional healthcare regulators to be clear that all regulated health professionals—not just doctors—must declare their interests, and that that information must be published by their employers. That approach will give not just women but all patients the reassurance that there are no interests involved in clinical decisions made about their care. We are working with the Care Quality Commission and equivalent organisations, and with the devolved Administrations, to ensure that implementation is monitored and that there is local accountability.

Recommendation 8b touches on the mandatory reporting of the industry. It calls for the pharmaceutical and medical devices industries to establish payments made to teaching hospitals, research institutions and individual clinicians. On 24 January this year—just a few days ago—an amendment to the Health and Care Bill was tabled to give the Government the power to deliver on that important recommendation. That legislation will, I hope, come into law fairly soon. The amendment will enable the Secretary of State to make regulations requiring companies to report information about their payments to the healthcare sector. That measure will benefit patients, who will see payments made to their doctors or hospitals, and it will build on proactive initiatives by healthcare regulators and the industry.

I very much take on board Members’ feeling that it took too long to acknowledge the problems that those women have faced, whether because of mesh implants, sodium valproate or Primodos. Although this may not be of any reassurance for women who have already been affected, we now have measures in place to flag problems in the system. For maternity care and clinical negligence, for example, we have an early notification system so patterns of events around neonatal care and foetal abnormalities are picked up at an earlier stage, to get on top of the causes quickly. We are seeing improvements in maternal and neonatal outcomes as a result of that early warning notification system

We very much recognise that such problems did happen in the past, but measures are being put in place to make sure that they do not happen in the future. I certainly want to make sure that the women affected are getting the care and support that they need. I very much take on board the points raised by hon. Members. I am very happy to keep Members updated on progress. I meet Baroness Cumberlege regularly to address the issues raised in her report.

I reassure colleagues that many of these issues will feature in the women’s health strategy, which we will publish shortly. The women’s health ambassador, the patient safety commissioner and I will be working hand in glove to make sure that women’s voices are heard in relation to their healthcare, and that we end the pattern of women feeling that they are not being listened to, that they are palmed off, and that their concerns are not taken seriously.

NHS Hysteroscopy Treatment

Liz Twist Excerpts

Monday 31st January 2022 Commons Chamber

[Ms Brown]

I agree with the hon. Gentleman and I am grateful for his intervention. I know he has been in these debates with me, and he makes the same point: no woman should have to go through this. No woman should be held down while procedures happen because they are screaming with pain and they want the pain to stop.

Another woman who contacted me about a hysteroscopy that took place last year told me that she had never experienced so much pain—not from a hip operation, nor from having her spleen removed. As a result of her traumatic experience, she now has anxiety and has been prescribed tablets by her GP just to help her function with the day-to-day. Like Jane, she is losing sleep and no doubt her broader health has been harmed by this. She does not know whether she has cancer, but she told me that she is now too scared to go to the hospital for anything.

There are so many stories that I could have told today. I am sent so many of them, despite the fact that the issue does not get a huge amount of press. Women who experience this are seeking out me and the charity I work with to tell us about it. If there were more publicity, more women would come forward. I really hope that the Minister understands that this is an issue of patient safety, but also an issue of common decency. It is an issue of confidence in the medical professions and the NHS, and it will be costing us all, both in money and in lives, because problems simply are not being caught early enough.

[Liz Twist (Blaydon) (Lab)]

I have the privilege of co-chairing the all-party parliamentary group on women’s health. We held a meeting at the end of last year to talk about women and the health service, and I must admit that the meeting lit up when one of the medical people spoke about women’s experiences and, in particular, hysteroscopy. I could not believe what happened on my Twitter feed immediately afterwards. So many women were sharing their experiences, listening and saying, “We are entitled to have our experiences of pain validated, and to not have to go through that pain.” Does my hon. Friend agree that the women’s health strategy, which we will be talking about increasingly often, must involve accepting those experiences and seeking to listen more to women, validate their experiences and ensure that the right anaesthetic and treatments are provided?

[Ms Brown]

I entirely agree with my hon. Friend, and that will indeed be an ask I have of the Minister at the conclusion of my contribution. My hon. Friend is right: women are not listened to. When they tell a doctor, “This hurts. I am in pain and I can’t bear it,” their experiences are not considered valid. They are told that they are being hysterical or overreacting and that they need to be as strong as the other woman he saw last night, last week or whenever, and to not be such a baby in demanding that the procedure be stopped.

Another case from last year is that of Sandy. When Sandy was referred for a hysteroscopy, she was told that pain was a risk, but the information that followed about local pain relief gave her false reassurance. She assumed that it meant some kind of anaesthetic. When she met the clinician, he told her that it would be like period cramps. When she asked about pain relief, he just repeated, “No more than just period cramps, if there’s any pain at all.”

Sandy was well acquainted with period pains. She had had coils inserted and had given vaginal birth twice, one with no pain relief, so she knew she was tough and she thought she would be fine. But when the hysteroscope reached Sandy’s uterus, she felt

“the most incredible, searing, tearing pain I have ever experienced. I found the arms of the bed to grab onto and could hear myself shouting no no no stop stop stop.”

Madam Deputy Speaker, you will be glad to hear that on this occasion the clinician did actually stop, but I would say that by that point the damage had already been done. Sandy has no memory of any questions asked or what the clinicians said to her afterwards. She just remembers the pain, the shaking and the shock. She was completely and utterly dazed, but scant minutes after enduring this, Sandy was ushered out the door. She was given no time to rest and recover, and she was so confused because she had been made to feel that she had made a terrible fuss about nothing. Sandy then had to drive herself home. She told me that she has gone from being fearless and confident to being terrified of going back at all.

Finally, I want to mention Penny. She told me what happened after her “brutally painful failed hysteroscopy”. She strongly, and understandably, believes that she was misled about the risk of pain, because if she had known, there is no way she would have consented to having the procedure with just painkillers. Immediately after Penny went through the same agony that I have just described, she had an assessment with a nurse. The nurse told Penny how she had seen many women like her traumatised and in tears after hysteroscopies. The nurse said that she would never, ever go without a full anaesthetic herself, and that to do the procedure on women with no anaesthetic was barbaric. Penny was deeply and rightly angry to hear this, and the nurse was very clear that women were going through this without being fully informed of the risks.

Let us be really clear: the women I have spoken of today are the tip of a massive iceberg. That nurse is right, the GP I mentioned earlier in the debate is right, and there are many others within the NHS who recognise that this is simply unacceptable. So what needs to change? Frankly, there is still a massive problem with the attitude that many doctors take towards women patients. Our words and our wishes are ignored, and when our words are ignored, our rights are ignored. That has got to end, and I believe that that takes a culture of change. I do not accept that there are just a few badly trained, uncaring or even sadistic doctors. There is a broader problem that the Government and the NHS must address.

The Government have talked previously about a women’s health agenda, and before that there was the women’s health taskforce. Now, there is going to be a women’s health strategy. Believe me, the word “strategy” is music to my ears, but I want a guarantee from the Minister today that tackling painful hysteroscopy will be a core issue. That is my first ask. The patient groups that have been raising this issue so forcefully over many years must have a seat at the table in discussing and monitoring that strategy. These issues are common and the structure of the NHS is complex and obscure; it is failing to listen. So we need to find ways to ensure that patient outcomes for hysteroscopies are measured and monitored alongside the strategy.

My second ask is for all NHS trusts to offer patients who need a hysteroscopy a full range of anaesthetics and to inform them accurately about the risk factors for serious pain, so that all women can make an informed decision. That will require more anaesthetists and theatre capacity for hysteroscopy patients. My third ask is that the Government ensure that this investment is made, and that the commissioning decisions required are being made by NHS trusts. In my view, this is something that the women’s health strategy should be measuring and monitoring, alongside robust evidence on women’s experiences of NHS hysteroscopy, over the coming years.

How many hospital trusts are actually following the guidance to offer anaesthetics up front to all hysteroscopy patients? How many offer a range of effective anaesthetics and have trained staff to discuss women’s risk factors so that they are given an informed choice? How many women are forced to endure a traumatic failed hysteroscopy without pain relief, with public money wasted as a result, only to have another procedure under anaesthetic?

How many patients do not even know they are going to be asked to have a hysteroscopy until they attend an appointment, with all the pressure that that involves? Can Members imagine going to a doctor in a hospital because of a fear that they have cancer and that doctor telling them they are going to do a hysteroscopy right now? Can Members imagine how much pressure there is on a woman to accept that procedure there and then because of the fear of what might be there and how long they might have to wait? They do not want to upset the doctor, do they? They might have something really awful that needs to be attended to immediately.

Any women’s health strategy worth its name would make sure that the answers to the questions I have asked are known and that we are moving in the right direction on all those issues. I am delighted to say that the best practice tariff on hysteroscopy, which financially incentivised the mistreatment of women, is now gone. We had a system under which our hospitals were paid more for hysteroscopies done without anaesthetic than they were paid for those done with anaesthetic. I am thankful that that incentivised mistreatment of women has now gone. That is a massive achievement for the campaign.

Several previous Ministers have engaged with me on this issue—the hon. Member for Thurrock (Jackie Doyle-Price) was very good on it when we spoke—and I thank them for hearing me. One benefit is that trusts are now paid the same amount for out-patient and day-case hysteroscopies. That is far better than it was, but it can still cause problems, because day-case procedures with anaesthetic cost more. If a trust will not be compensated for the difference, it might still decide to try to limit access to pain relief, because it will know that if anaesthetic is given, it will not receive a benefit in kind to pay for that procedure. We need to know that individual trusts are actually changing their behaviour and attitude in response to the progress that has been made. If they are not, we might need further action to ensure that no trust will lose money by doing the right thing and providing the pain relief that a woman needs.

I am sure the Minister will be slightly alarmed by an increase in demand for anaesthetists and theatres, and we all understand the massive covid backlog that the Government and the NHS face. I reassure the Minister that both regional or spinal anaesthetic and intravenous sedation with anaesthesia may be good options for many hysteroscopy patients, depending on their needs and risk factors. The NHS has got to offer a real choice in the range of anaesthetics, not a false choice between a general anaesthetic and no effective pain relief at all. It is simply wrong that if a man needs a colonoscopy, the chances are that he will be offered an effective anaesthetic without question, whereas if a woman needs a hysteroscopy, they may be forced to endure such terrible trauma that it shakes them to the very core ,and then made to feel pathetic when they cry out in pain.

I am not going to stop raising this issue, and the courageous women I have been working with will not stop either. I want to work with the Minister on this issue, as I have with other Ministers in the past, and I hope the Government engage fully, because we need to end this scandal and ensure that women are treated like human beings in every single part of our NHS.

Covid-19 Update

Liz Twist Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

First, I hope that the Wray family will have many more holidays. No one wants this to be their last holiday as a family, but I am pleased that they can go ahead with their plans and that they will be able to access that proof for their children today. On the question of daily contact testing, I can confirm that people who are vaccinated—they have to be vaccinated—and isolating today will be able to move from isolation into daily contact testing from tomorrow, subject to the will of the House. On the opening hours, they will be increased, certainly for all the large vaccination centres. The minimum will be 12 hours, but many of them will be going way beyond that.

[Liz Twist (Blaydon) (Lab)]

The aim is to get high numbers given their booster through the booster programme by the end of the year. How will the Secretary of State ensure that inequalities are not generated by the push for numbers rather than need? I am thinking of those who may not be able to access the various systems digitally and those in areas of health inequalities.

Covid-19 Update

Liz Twist Excerpts

Wednesday 8th December 2021 Commons Chamber

[Mr Speaker]

The final question is from Liz Twist.

[Liz Twist (Blaydon) (Lab)]

Thank you, Mr Speaker. The Secretary of State rightly emphasised the importance of vaccines, but the Government have fallen short of their target to offer all 12 to 15-year-olds the vaccine by October, so what will he do to ensure that programme is speeded up and rolled out?

[Sajid Javid]

We recently took measures to increase take-up among that age group by allowing those children, with their parents or guardians, to use the national booking system and the walk-in facilities, and that has certainly helped boost take-up.