Mental Health Services: Sign Language Users

Lord Borwick Excerpts

Monday 2nd February 2015 Lords Chamber

[Lord Borwick (Con)]

My Lords, I declare an interest as a trustee of the Ewing Foundation for deaf children.

I am grateful to the noble Lord, Lord Ponsonby, for again raising for debate important issues on deafness, but I rather disagree with the noble Lord on the definition of deafness. It should not be defined as the characteristic of those who use sign language, because there are a host of elderly deaf people who do not use BSL and many children born with a profound hearing loss now have cochlear implants which, although leaving them still with a significant hearing impairment, enables them to communicate in spoken languages. Similarly, improvements in hearing aid technology have made it easier for other deaf children to communicate in a spoken language. The Oxford English Dictionary defines “deaf” as lacking the power of hearing or having impaired hearing. That is the definition we should use; a definition that depends on BSL implies that BSL is the only characteristic, and that is problematic.

Today’s debate is particularly important because there is a lot of evidence of depression and mental health issues among deaf people, including those who use sign language. All the evidence suggests that hearing loss can substantially increase the risk of mental health problems. Anxiety, paranoia and depression are particular risks. Those with hearing loss are overrepresented among samples of patients suffering from paranoid psychoses in later life. Older people with hearing loss are more than twice as likely to develop depression as their peers without hearing loss. It is therefore important that the appropriate mental health services are available for deaf people and that the right steps are taken to improve outcomes.

I know that some will argue that, because not everyone can use sign language, deaf people who use it may experience depression and mental health issues even more acutely. Deaf people using sign language to communicate may have fewer opportunities to access appropriate special services too, and there are still a few children who use BSL as their only language who would struggle to access mainstream mental health services because of language barriers. This no doubt accentuates the feelings of frustration. There is research showing that deaf children who live in families where BSL is the only language are less likely to experience mental health problems than deaf children in families who use English. If you cannot communicate with your family, it is little wonder that you feel isolated. However, that research is dated.

New technology, such as digital hearing aids and cochlear implants, is reducing the need for the BSL language, and early detection is further breaking down the reliance on BSL. We have to remember one crucial point in this debate: there is a whole range of deafness, and not all the people on the spectrum use BSL, but new technology and early detection mean that many more can take a full and active part in a hearing society while still being able to use sign language if they choose. Doors are opening and many deaf people or partially deaf people can enjoy the best of both worlds rather than becoming frustrated by the limitations of just one. Being able to access both deaf and hearing communities is going to be good for the mental health of those with hearing difficulties.

Much more care is being taken to focus on the mental and emotional health of deaf children. The National Sensory Impairment Partnership has worked with the National Deaf Children’s Society to produce documents for teachers of the deaf on emotional well-being. The website for the National Sensory Impairment Partnership has published guidance for teachers on how to deliver a course called Think Right Feel Good. This helps teachers to understand and develop emotional resilience in deaf children.

There are a host of foreign languages in the UK. All speakers of unusual languages have the same problem: the inability to communicate except in their own community. The number of deaf young people who are reliant on BSL to communicate and access teaching and learning has declined significantly, and this will be reflected over the next few years in the adult population. I am full of admiration for the wonderful children who use BSL while learning to read and write English at the same time, but technology is changing that and we have to embrace it. It is so exciting that we can bring deaf people into the speaking world. Look at the new apps available on smartphones nowadays. Google Translate and Skype Translator both instantly translate foreign languages. Siri is starting to do so on Apple products. The app Mimix says that it will simultaneously translate from English into American Sign Language. MotionSavvy will translate the other way. I am sure it is not yet perfect, but a great start would be for BSL users to carry this sort of technology when having a vital conversation with a doctor. This is a story of success—not perfect by any means but apparently getting better.

It is, of course, very sad that the situation was so bad in the past, but the important thing is that things get better, and it will be ameliorated by technology, not by government expenditure. The overall priority should be to integrate deaf children into society, and as a fully integrated group they will no doubt have a similar incidence of mental illness, tooth decay and cancer as the rest of society. Any incidence of mental illness is appalling, but I am not sure that it is sadder because the victim is deaf than because the victim speaks Pashto or Welsh.

I ask my noble friend the Minister if he is able to publish data on the characteristics of children referred to specialist deaf mental health services. What percentage of the children are lip-readers, use BSL or have cochlear implants? I believe that more information will only help us to learn and improve. It would be very helpful to see the data on the characteristics of children referred to specialist deaf child and adolescent mental health services to see what we can learn. If we were aware of the most common profiles of children referred to the specialist services, perhaps this would inform preventive work and where it should be targeted.

Mesothelioma: Research Funding

Lord Borwick Excerpts

Thursday 16th January 2014 Grand Committee

[Lord Borwick (Con)]

My Lords, I declare my interest as a trustee of the British Lung Foundation. Lung diseases are predominantly diseases of the poor because they are often associated with tobacco. Because of this association, there is a strange guilt attached to lung disease, and so the level of research generally into lung diseases is very low.

Asbestos exposure is a subject that is correlated with workmen who dealt with asbestos in the construction or shipbuilding industry at a time when it was regarded as a safe, reliable fire protection. We now know that it is a killer. Like Jimmy Savile, that which was presented by the BBC as safe and cuddly turns out in reality to be a monster. It is very difficult to raise money for lung research because of this guilt complex and, as a result, the BLF has a turnover of about £6 million per annum, which is tiny in comparison with that of the British Heart Foundation. I am afraid that the British Government seem to have been affected by this as much as others. It is only recently that the Government have been working hard to help with fundraising for research into this, and of course they have been doing so against a background of a dreadful recession. It is hard to raise funding at this time.

If we look at breast cancer, a disease that 40 years ago was seen as being just as fatal as mesothelioma is now, the prospects have been transformed by good research and by attracting the best researchers into working on that subject, and the same could be done for lung disease. Normally I believe that the private sector will always be better than the Government at achieving almost anything, and I should pay tribute to the four insurance companies which funded the first three years of the research push. They are Axa, Aviva, Royal Sun Alliance and Zurich—heroes all. However, the insurance industry is beset by the problem of free riders—those who gain the benefit without picking up any of the cost. Notably this has happened in the car insurance industry, and even with modern number plate recognition the cost of uninsured drivers in accidents is an enormous burden on the price of motor insurance. Is that not structurally similar to the cost of insurance companies not contributing to the research fund for mesothelioma?

A general problem for lung disease is the guilt implied by the reaction of so many people. Even if people choose to smoke or do not have the ability to give up an addiction, no such criticism should possibly be made of mesothelioma patients. The sad thing is that Governments in the past have generally not treated the subject of lung disease with the importance or priority that other diseases have achieved. I do not want to criticise past Governments, but I will say that the general level of research into lung disease is much less than into other diseases. Of course, I applaud the work that the Minister has been doing in trying to negotiate more funds. The Government certainly believe that they are enlightened—even the whole source of enlightenment—so can I suggest that lung disease is a cracking good place to prove it?

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I thank the noble Lord, Lord Alton, for having tabled this debate. Mesothelioma is, as we have heard, a terrible and devastating condition. There is no cure and uncertainties remain about the best available approaches to diagnosis, treatment and care. It is therefore completely right and appropriate that mesothelioma research has been discussed a number of times, both here in your Lordships’ House and in the House of Commons.

Funding is, of course, needed for further research to be carried out. The four largest insurance companies have previously made a donation of £3 million between them, and this is supporting valuable research into the disease. A higher level of funding has come from government—through the Medical Research Council and the National Institute for Health Research. Together, these funders spent more than £2.2 million in 2012-13.

The MRC is supporting ongoing research relating to mesothelioma at the MRC Toxicology Unit and is also funding two current fellowships. The NIHR is funding two projects in mesothelioma through its Research for Patient Benefit programme, and its clinical research network is recruiting patients to a total of eight studies, including industry trials. The NIHR funds 14 experimental cancer medicine centres across England with joint funding from Cancer Research UK, and these centres have four studies focused on mesothelioma.

However, as I have said previously, the issue holding back progress into research into mesothelioma is not—as a number of noble Lords have intimated—a lack of funding but the lack of sufficient research applications. I want to clarify and stress that the work currently being funded is of high quality, and that is consequent upon high-quality applications.

Money is available to fund more research, but measures are needed to stimulate an increase in the level of research activity. That is why the Government have committed to doing four things and I am delighted to have this opportunity to report on progress to the noble Lord, Lord Kakkar, in particular, and other noble Lords who have spoken with considerable insight in today’s debate.

First, we promised to set up a partnership to bring together patients, carers and clinicians to identify what the research priorities are. This is now well under way and a formal launch event took place successfully last month. It is supported and guided by the James Lind Alliance, which is a non-profit initiative overseen by the NIHR Evaluation, Trials and Studies Coordinating Centre. The partnership has a steering group of 16 people, comprising six patient/carer representatives and 10 clinical representatives.

The next stage is a survey asking patients, families and healthcare professionals for their unanswered questions about mesothelioma treatment. The partnership will then prioritise the questions that these groups agree are the most important and the end result will be a top-10 list of mesothelioma questions for researchers to answer. The partnership plans to have the list ready by the end of this year, when it will be disseminated, and work will begin with the NIHR to turn the priorities into fundable research questions.

Secondly, the NIHR will highlight to the research community that it wants to encourage research applications in mesothelioma. The launch of this highlight notice will take place in advance of the identification of research questions by the priority-setting partnership to prepare researchers.

Thirdly, the NIHR Research Design Service will be able to help prospective applicants develop competitive research proposals. This service is well established and has 10 regional bases across England. It supports researchers to develop and design high-quality proposals for submission to the NIHR itself and to other national, peer-reviewed funding competitions for applied health or social care research. The service provides expert advice to researchers on all aspects of preparing grant applications in these fields, including advice on research methodology, clinical trials, patient involvement, and ethics and governance.

Finally, we have made a commitment to convene a meeting of leading researchers to discuss and develop new proposals for studies. Initiatives like this are one reason why it is so valuable to have the National Cancer Research Institute, the NCRI, which enables the major funders of cancer research to work in strategic partnership. I can report that NCRI officials held a meeting with clinical research leads yesterday, 15 January, to develop plans for bringing researchers together, and a representative from the British Lung Foundation also participated. The outcome was encouraging: the NCRI will be organising a mesothelioma workshop in the early summer with the aim of encouraging competitive grant applications in the field of mesothelioma. This will cover the full spectrum of basic, translational and clinical research.

Several noble Lords have—not unnaturally—spoken of a need for an ongoing role for the insurance industry in funding mesothelioma research. While the Government have money available to fund high-quality mesothelioma research proposals, we are also encouraging insurers to provide further funding. My honourable friend the Minister for Disabled People, Mike Penning, has met the Association of British Insurers, and following that meeting I have written to the association’s director general, Otto Thoresen. I am pleased to say that he has confirmed in a reply today that a further £250,000 will be paid directly to the British Lung Foundation. He has also confirmed the industry’s commitment to explore with the Government the range of future funding options. We would welcome another opportunity to meet insurers to discuss this.

[Lord Borwick]

I thank the Minister for that news. I also have a copy of the letter. The £250,000 is very useful, but it is less than one single claim from a sufferer of this disease. This has to be a short-term solution. If the voluntary agreement mentioned by the noble Earl does not happen for some reason, will the noble Earl push for legislation to make it happen compulsorily?

[Earl Howe]

My Lords, I note my noble friend’s question. My best answer to him at this stage is “one step at a time”. However, I can assure him that we will use our best endeavours to see a successful outcome from our discussions with the insurance industry. It is perhaps premature for me to go further at this stage.

Smoking: E-cigarettes

Lord Borwick Excerpts

Tuesday 17th December 2013 Grand Committee

[Lord Borwick (Con)]

My Lords, first, I declare an interest as a trustee of the British Lung Foundation. Lung disease can affect everyone but it seems to be particularly prevalent in the poorest parts of the country. Of course, heavy smoking is strongly correlated with poverty.

Tobacco is by far the largest cause of lung disease, and a very large number of people suffer debilitation and a painful death because of it. I have many friends who have spent their lives trying in vain to help people addicted to cigarettes, and it is understandable that they passionately hate anything to do with smoking, including e-cigarettes.

When I visited the Consumer Electronics Show in Las Vegas, which I think is the largest trade exhibition in the world, in January this year, I saw about 200 Chinese manufacturers of e-cigarettes open for business. There is a tide of these things coming. They were the most common new product at the show after iPhone cases. One could wish that they would just go away, but of course they will not. So I congratulate my noble friend Lord Astor on opening this debate. Many people have been wishing e-cigarettes away; this is a useful chance to debate them.

People are addicted to nicotine but it is the tar that kills them. This seems well established. However, part of the addiction to cigarettes is not just the chemical nicotine but the handling of a cigarette, the sociability and the feel of it. Certainly, e-cigarettes provide a substitute for some of these sensations. They seem a reasonable and less dangerous product than conventional cigarettes.

The trouble is that we are fighting the battle against the killer tobacco on three fronts: on cost, by increasing consumption taxes; with education at earlier stages to ensure those likely to start smoking, namely teenagers, are aware of the risks involved; and by making cigarettes abnormal, by keeping them locked behind shutters at the supermarket and with other proposals such as plain packaging. It seems that the third front, denormalisation, is at least as powerful as the other two. The concern is that e-cigarettes can undo a lot of the good work that has been done to make smoking an unusual habit and smokers akin to pariahs. If it is okay to smoke e-cigarettes, will it become okay to smoke normal ones again? Will users ever kick the habit of enjoying nicotine and holding a cigarette?

Another important question must be addressed: what are e-cigarettes? Do they contain just nicotine and vapour, or anything else at all? This seems to call for regulation as a simple product, to ensure quality. Will my noble friend the Minister encourage his department to sponsor some research into the effects of nicotine alone? It is said to be dangerous to those with a heart problem or to pregnant women, but the truth is that there has not been enough research on the subject to be sure.

It is important to understand how e-cigarettes are changing the behaviour of smokers of conventional cigarettes. ASH has reported that as many as 1.3 million people occasionally use e-cigarettes and that 400,000 people are using e-cigarettes in total or partial replacement of normal cigarettes. That is great news.

The danger people spot is that children might become more likely to take up normal cigarettes after trying e-cigarettes. We cannot tell if that is so, because there has been not been any research on it, but logic suggests otherwise. Teenagers smoke cigarettes to look cool, and e-cigarettes are not cool—they are about giving up an addiction. No teenager wants to look as though they are giving up something: they want to look as though they have no problems.

According to research from the Institute of Economic Affairs from July 2013:

“Far from acting as a gateway to smoking, all the evidence indicates that e-cigarettes are a gateway from smoking”.

Evidence from ASH supports that statement. Indeed, the fact that 400,000 people have given up cigarettes is great news, and if we concentrate on that, we should say that there should be no real restriction on the sale or advertising of e-cigarettes. If they are mainly used by existing smokers as a way of quitting, we could even do good by giving them away to smokers.

If we are to have any regulation, it should be of the quality of the contents alone: restricting the ingredients to nicotine; ensuring damaging toxins are kept out of them; and not allowing flavoured e-cigarettes specifically designed to attract children, such as bubblegum e-cigarettes or such like.

In choosing today for this short debate, my noble friend Lord Astor has shown a downright astonishing ability to predict the future, because a provisional deal was reached last night in Brussels between MEPs and national Governments on a new tobacco products directive. Martin Callanan MEP has said that this directive will take the majority of e-cigarettes off the market. It would restrict all but the weaker e-cigarettes, even though smokers who are considering using e-cigarettes to break their addiction tend to begin on stronger e-cigarettes and gradually reduce their usage. Making stronger e-cigarettes harder to come by will encourage smokers to stay on tobacco. Among the points made in the draft directive, paragraph 3.7 states that its purpose is to stop the situation whereby,

“more people—unaware of the content and effects of these products—inadvertently develop a nicotine addiction”.

The idea that somebody will inadvertently become addicted without the help of the EU seems rather unlikely.

Finally, I pose a conundrum for the Minister. If we go ahead with plain packaging for cigarettes—which are actually illustrated with lurid photographs of health problems—do we allow e-cigarettes to be sold in similar packages if the manufacturer wants to? That is something that the great Sherlock Holmes might perhaps describe as a “three pipe problem”.

Ageing: Public Services and Demographic Change Committee Report

Lord Borwick Excerpts

Thursday 17th October 2013 Lords Chamber

[Lord Borwick (Con)]

My Lords,

“Old age ain’t no place for sissies”,

as the late, great Bette Davis once said. This excellent report underscores the importance of that statement, and in markedly better English too. I am grateful for the opportunity to deliver my maiden speech on a subject so vitally important.

I took my oath on 29 July, after the whole House so generously elected me as a hereditary Peer to the Conservative Benches. I noticed that your Lordships considered my arrival and immediately went on Recess. This allowed me, though, to wander the temporarily lonely corridors of this fine building and to consume the time so unselfishly given by so many of the senior staff to bemused new Members such as me—and what an extraordinarily talented group of directors and senior staff I have met. My thanks are due to all of them, and particularly to my whip and mentor, my noble friend Lady Perry of Southwark.

My previous career has been in the automotive, housing and finance industries, but with a constant thread of disability. The reason may be that our two eldest sons had very bad heart defects when they were born. Our eldest son had to spend his entire first year of life in the intensive care ward at the great Royal Brompton Hospital, leaving him with some permanent disabilities. However, my wife Victoria and I are great believers in the American maxim, “When life gives you lemons, make lemonade”. Perhaps this is why I worked to make the London taxi wheelchair accessible. The secret was to make the accessibility ordinary rather than extraordinary; to make it normal and not mark it with wheelchair signs.

Disability will be ordinary in the future of our ageing society, as ordinary as hearing aids and glasses are today. The truth is that every one of us spends time in a wheelchair. That wheelchair is called a pram, or maybe I should say a baby buggy now, and we are very lucky if it is only at the beginning of our lives that we need such a wheelchair. If our physical environment must change to become even more accessible, our younger citizens had better start demanding it now so that it is ready when they need it for themselves. And yet our young people ignore their longevity—a point made in this remarkable report.

As the report says, arbitrary age triggers are out of date now, such as getting a free BBC TV licence at the age of 75 or being compelled to retire at any particular age whatever. Age-based benefits become increasingly absurd as the population grows older. Nobody knows better than the individual how well he or she is ageing. Many people will be able to start whole new careers when they are retired. In America, the Prudential advertises pension savings plans with the strap-line, “If you could pay yourself to do what you love in retirement, what would you do? Would you be a teacher? Would you be a musician or a painter?”. That is the optimist’s point of view. For many people who have saved wisely, the freedom to take risks and learn new skills will be very attractive. Many of us here in the House certainly are lucky to have started whole new careers as parliamentarians. The point is that arbitrary regulation by age is flawed.

Two differences stand out about the current cohort of young people who will eventually become Britain’s ageing population. The first is that they are definitely more computer literate than today’s average pensioner. They will expect information to arrive via the internet, not through newspapers or TV. Monitoring their health, happiness and well-being will be so much easier and cheaper in the future. We also need new ways to reduce their loneliness.

The second difference is that the level of debt they will bear will become heavier than anyone imagines, both as their share of our national debt but also through their own personal debts. I do not know what brouhaha will erupt when it finally dawns on people how much their predecessors have spent, leaving the bills to be financed later. The cost of servicing debt will inevitably claw into the cash available to look after our older citizens.

Next month Britons will remember fondly the veterans who gave their lives to protect our nation from destruction in two world wars. I hope that in decades to come Britons as yet unborn will look back in gratitude at what today’s leaders did to bequeath them a financially sound economy with debts at lower and more manageable levels.

There is nobody more aware of the value of experience than a brand new Member of your Lordships’ House, surrounded by the experienced people who constitute his new colleagues. I look forward to learning from all of you.