Vaccine Damage Payments Act

Baroness Berger Excerpts

Tuesday 24th March 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Caton. I pay tribute to my hon. Friend the Member for Dumfries and Galloway (Mr Brown) for securing this important debate and for his work as chair of the all-party group for vaccine damaged people. His tireless campaigning on behalf of his constituents, and others who have been affected by vaccine damage, is commendable.

I also thank all hon. Members and right hon. and hon. Friends for their contributions throughout the debate, which are testament to the strong feelings about this issue on both sides of the House. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) talked about the challenges experienced by her constituents. The hon. Member for Strangford (Jim Shannon) made a large contribution and I was specifically interested in hearing what he said about the emotional trauma experienced by families. The hon. Member for Newbury (Richard Benyon) and my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) both talked about their constituents’ experiences of the HPV vaccine.

Vaccinations are crucial to our NHS as a way of preventing disease and the spread of infection. The research and discoveries made every day by the scientific community lead us closer to disease prevention that could not have been imagined when the Vaccine Damage Payments Act 1979 was passed. The improvements in vaccine uptake in recent years have resulted in a greater proportion of children being vaccinated now than ever before.

As my hon. Friend the Member for Dumfries and Galloway made clear the purpose of today’s debate is not to question the importance of the national vaccination programme to the health of our population; instead, it is to bring to the House’s attention those occasions on which vaccinations have gone wrong, with deeply distressing and life-changing consequences, and the challenges surrounding the support system in place for those people who are sadly affected.

I recently attended a meeting of the all-party group in Parliament and at another meeting I met a group of parents and their daughters who had been affected by the HPV vaccination. The stories I heard in both meetings highlighted that, in the event of such tragedies, it is vital that people who suffer from vaccine injury can expect to receive support to ease the burden on them and their families. They certainly should not have to battle to get what they are entitled to.

At those meetings, the deep sense of injustice felt by many of the families who live every day with the burden of disability caused by vaccine damage was clear. In response to my right hon. Friend the Member for Wolverhampton South East, I should say that I hope that the parents and people affected believe that I was at that meeting to listen to them. I very much appreciate that they feel that they are not being listened to, on top of the challenges that they have faced over many years.

As we heard, the vaccine damage payments scheme was established under the Vaccine Damage Payments Act in 1979 to provide tax-free lump sum payments to people severely disabled as a result of vaccination against specific diseases. Despite the gradual expansion of support under numerous Governments and some important reforms made in 2000 following a review of the scheme, the system has many challenges today. We have heard many compelling reasons for reform.

Since the scheme was first introduced, the number of payments made has fallen dramatically. As my hon. Friend the Member for Dumfries and Galloway said, since 2010-11 no vaccine damage payments have been made at all. That may be down to vaccines and vaccine safety, but it is troubling that, despite hundreds of applications from people whose disability was sufficient for them to be considered to have a strong enough case, not one payment has been made. I hope that the Minister will explain why such a gulf exists between applications for support and actual payments made. I hope she will share her view on why the number of payments has gone down to zero in recent years.

I understand that there is a robust qualification process and that, to qualify for compensation, a person must be assessed to be 60% permanently disabled for life. In considering cases, it is right that medical advisers have regard to whether informed medical opinion suggests that there may be a causal link between the claimed adverse event and vaccination. I appreciate that the line must be drawn somewhere, but will the Minister share with us whether any flexibility is built into the system to allow a person assessed as being very close to the 60% qualification point—perhaps they are 59% permanently disabled—to receive support under the scheme? Surely a person suffering such a level of disability has a substantial need, which the scheme is intended to accommodate. It seems unjust that, by just missing out on the threshold, they would receive no payment at all under the scheme, so it is left to the family to shoulder that burden.

Has the Minister considered the case for reforming the minimum level of disability required for a person to qualify? We have heard today that, even when a person does qualify as having a serious disability, the Government have fought against such decisions. Take the case of people who suffer from narcolepsy as a result of the swine flu vaccine, which we have heard about today. Despite a causal link with the vaccine having been established and a tribunal having concluded that that should be considered a “serious disability,” the Department for Work and Pensions appealed against the decision. Will the Minister share with us why the DWP would go against such a decision? Will she clarify how her Government reach a decision on whether to appeal against a tribunal decision?

As we have heard in the debate, there are many other anomalies in the coverage provided by the Act. I note the recent additions this year of the rotavirus and influenza vaccinations to the list of specified diseases to which the Act applies. Despite that, it does not provide a comprehensive safety net. Will the Minister explain the review process that takes place before a vaccine is included on that list? Why are some vaccines, such as pandemic influenza and hepatitis A and B vaccines, excluded? The current scheme focuses largely on the childhood immunisation programme, but it covers people over the age of 18 for certain diseases. We have heard the word “patchy” used today, which is a fair assessment.

I was concerned to learn that 814 applications had been rejected on non-medical grounds because they were made either out of time or outside the scheme’s scope. The scheme allows for no extension to the time limit, even when the applicant did not have knowledge of the scheme or did not know that they might qualify for a claim. To refuse someone the support they need on the grounds that they have not made the deadline seems inflexible. Does the Minister have plans to build more flexibility into the rules about the time frames in which applications need to be made?

There are other anomalies. In the event that a child under two dies from an adverse reaction to a vaccine, their family are not eligible to receive any payment under the scheme. The logic for that is unclear. Why should the family of a child who dies after their second birthday be more deserving of compensation than one whose child died a day before? I would welcome clarification from the Minister on whether she plans to review that.

In a written answer to me at the end of last year, the Minister said that the Government had

“no plans to make changes”

to the 1979 Act. Has she reconsidered that position since then? If not, does she have any plans to review that decision?

The debate has raised issues that need to be tackled if we are to ensure that we have a comprehensive support system for vaccine damaged people and to promote confidence in the uptake of vaccines. The support scheme put in place by the 1979 Act was of its time and intended to be an interim solution. However, it has become—albeit with some changes over the years—a permanent one.

People need to be assured that, in the unlikely event that something goes wrong, they will be looked after. My hon. Friend the Member for Dumfries and Galloway made a powerful case for reform, which I hope the Minister will take away and give her full consideration. I look forward to her response.

Child and Adolescent Mental Health Services

Baroness Berger Excerpts

Tuesday 3rd March 2015 Commons Chamber

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

I thank the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), and the other members of her Committee for their thorough and valuable report, and for giving us the opportunity to debate this important issue.

When we discuss complex commissioning and funding arrangements, as we are today, we must not lose sight of the people at the heart of the matter. I remind the House that we are talking about some of the most vulnerable children and young people, who are often scared and in states of high distress and trauma. They and their families deserve the very best care and support that our NHS can offer. However, as the Health Committee found, for too long they have been overlooked.

I think that anyone who has read the report would agree that it is damning in parts. It concludes:

“There are serious and deeply ingrained problems with the commissioning and provision of Children’s and adolescents’ mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people.”

We have heard that Members from all parts of the House share the concerns that are expressed in the report. It was valuable and helpful to hear not only from members of the Committee, but from other Members who have experience from their constituencies and from before they came to the House.

Many Members in this debate and in previous debates in the House have raised horrifying and tragic cases involving their constituents. Most Members know all too well the pressure that too many parts of CAMHS are increasingly under. Sadly, the reports of children facing long waits for treatment, being sent hundreds of miles for a bed or not getting any help at all are too common. In my capacity as shadow Minister for public health with responsibility for mental health, I have received too many messages from young people across the country that paint a picture of services that are under immense pressure and of waits that pass the three month and six month marks. Indeed, we heard from my hon. Friend the Member for Coventry North West (Mr Robinson) about constituents who have waited 44 weeks.

The Minister is open about the scale of the challenge and acknowledges that there is much to do. The Government accepted in their response to the report that the mental health and well-being support that is offered to children and young people, as well as to their families and carers, often falls short. The Government accept that there is a need to improve the system. Today’s debate has been a much needed contribution to the parliamentary and public understanding of the challenges that the system is facing. It has been an opportunity for the House to hold the Government to account on their response and on the action that they must now take to get to grips with these challenges.

The shortage of beds, which the Select Committee highlighted, is of great concern to many Members. The Government response refers to NHS England’s commitment to commission 50 more beds. We understand that NHS England has opened the majority of those beds. I hope that in his response the Minister will confirm when the remaining few will open. Does he consider the additional 50 beds to be sufficient, in the light of the pressures that CAMHS is facing?

The system clearly is not working in some parts of the country. Members on both sides of the House will have been shocked to read in The Observer a few weeks ago that commissioners from NHS England sent out an e-mail on a Friday night to warn that there would be a national shortage of in-patient beds for children over the weekend and that it was likely that children would need to be placed on adult wards. Almost a year ago, the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. I hope the Minister will say what more he can do to assess and reassess the situation.

Ensuring that we have enough beds to prevent children from having to travel hundreds of miles from home for treatment or to avoid being detained in police cells is, of course, critical, and Members have addressed that issue. However, as the Committee points out,

“commissioning extra inpatient capacity alone will not be enough to alleviate the current problems being experienced”

in relation to in-patient services.

I appreciate that some of the issues are long-standing historical challenges, but it is certainly fair to say that this Government’s reorganisation has exacerbated those challenges. The Committee’s report states:

“Despite the move to national commissioning over a year ago…NHS England has yet to ‘take control’ of the inpatient commissioning process, with poor planning, lack of co-ordination, and inadequate communication with local providers and commissioners.”

NHS England itself has acknowledged weaknesses in commissioning as a reason for bed pressures and patients being inappropriately admitted to specialised units. The Committee highlighted the concerns that professionals have been raising for more than a year about the new split in commissioning between tier 4 services, which are the in-patient beds commissioned nationally by NHS England, and lower tier services, which are commissioned by clinical commissioning groups. It does not take a genius to work out that that arrangement results in the perverse incentive for CCGs to refer children to tier 4 in-patient services, because they do not have to pay for them, rather than treat them in the community, where they have to fund the places. We know that treatment in the community can be so much better for many of those young people’s outcomes and their long-term recovery, but the current situation is exacerbating many issues and problems.

The Minister himself has said that current fragmented commissioning arrangements make “no sense” and are “dysfunctional”. It would be helpful to hear from him what more the Government plan to do to address the situation. In their response to the Committee, the Government said that their taskforce would look at determining a way in which commissioning can be sufficiently integrated. Given that we had to read about the taskforce conclusions on the pages of The Times a couple of weeks ago, perhaps the Minister will do us the courtesy of updating the House on what action the Government will take.

The Government have also announced that NHS England has funded eight pilots looking into collaborative joint commissioning arrangements for children and young people’s mental health, so it would be really helpful to have an update on the progress of those pilots.

The commissioning confusion caused by the NHS reorganisation would be a challenge in itself, but, combined with the cuts to local authority CAMHS and early intervention services, it is having a devastating impact. There has been £50 million-worth of cuts to CAMHS since 2010. There have also been cuts to local authority CAMHS and to early intervention in psychosis services, a reduction in social workers and a decimation of the early intervention grant in many parts of the country, which is putting pressure on in-patient services, particularly in areas with higher levels of deprivation.

I listened to the speech by the hon. Member for Brigg and Goole (Andrew Percy), but Liverpool’s budget has been cut by 56%. The idea that Liverpool city council is not interested in youth services could not be further from the truth, but the reality is that applying the funds available to it to youth services is incredibly challenging.

According to research by YoungMinds, two thirds of councils in England have reduced their CAMHS budget since 2010. When the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, it found that more than half of them had cut their budgets, some by as much as 30%. It is therefore unsurprising that the Committee reported that poor provision of lower tier services has likely been a key factor in the increase in the number of children and young people requiring admission to in-patient services.

In their response the Government refer to extra funding for early intervention in psychosis services and crisis care, but will that not merely take us back to where we were before these cuts? What proportion of the new funding that the Minister has announced will be directed towards services for under 18s? I am particularly interested in the work of the Government’s taskforce on ways to incentivise investment in early intervention—again, it would be helpful to have an update on that. Will the Minister match the Opposition’s ambition to increase the proportion of the mental health budget that is spent on children over time—again, that point has been raised by hon. Members on both sides of the House?

Schools are an obvious place for prevention work to take place, and I was interested to hear the intervention from the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) about the experience of schools in his area. The Committee found that in too many schools counselling services are unavailable, even though they can provide lower level preventive intervention that can stop problems subsequently becoming more serious. Again, will the Minister update the House on his work with colleagues in the Department for Education to improve that situation? Will he meet the Opposition’s commitment to produce a strategy to help local authorities with their local NHS and schools to work together, to ensure that all children can access school-based counselling or therapy if they need it? Does he agree that in future all teachers should have training in child mental health so that they are equipped to identify, support and refer children with mental health problems?

A few other issues were raised in the debate, although I am conscious that we want to hear from the Minister and I have just three minutes to respond. The work force were mentioned, as was ensuring that all GPs are trained in mental health. The Opposition have committed to ensuring that training for all professional staff in the NHS includes mental health. Does the Minister support that ambition? Data were mentioned by Members on both sides of the House, and up-to-date data and information are critical to provide safe and effective services that meet the needs of children, young people, their families and carers.

I share the Committee’s concern that the most recent data from the Office for National Statistics on children and young people’s mental health are now 10 years old, and the Minister said that CAMHS has been operating in a fog without that information. I welcome the commitment to a new national prevalence survey of child and adolescent mental health data, and that that is a priority. Again, it would be helpful to have an update on that. Can the Minister set out the time frame for work that will take place before February 2016 when we understand that that data set will start?

In conclusion, as we have heard, significant questions remain. Much of the Government’s response to the Committee’s report has referred to the work of the CAMHS taskforce, which the Minister has established and is yet formally to publish its report, even though elements of it have been leaked to the press. It would be helpful for the Minister to update the House on when the taskforce report will be published in full, and to say whether he intends to follow it with tangible action—I appreciate that there will be recommendations, but it would be helpful to know what the Government intend to do.

Children and young people are struggling with mental illness, and in some cases their illness is becoming so severe that they are turning up in A and E—just this week a response to a parliamentary question showed that young people are turning up in A and E with mental illness not just once but two, three, four or five times. They often wake up in hospital beds too many miles from their families and friends, and are simply not receiving any help at all. We are having this debate on their behalf, and I hope the Minister will tell the House what action he will be taking to put that situation right.

We must get to a point where a child can feel that it is as safe to talk about their mental health as about their physical health, and where all children feel that they can tell someone about their anxiety as easily as they can speak about their headache or a stomach bug. Crucially, when they do that they must get the help they need, when and where they need it. I look forward to the Minister’s response.

Health Service Commissioner for England (Complaint Handling) Bill

Baroness Berger Excerpts

Friday 27th February 2015 Commons Chamber

[Mr Arbuthnot]

It is worrying that my right hon. Friend is persuading me that I am wrong. It is very worrying, while one is on one’s feet, to be persuaded out of one’s own arguments. If he will allow me to cling on for just a few moments, I will get to the dregs of my argument.

The ombudsman might be the only champion of someone who is already vulnerable because they have been incapacitated to one extent or another by their health needs. Therefore, it would be a good idea to encourage the ombudsman to give as much information as possible to the complainant at the outset of the complaint, although my right hon. Friend is right, given his fourth or fifth Eric Forth principle on keeping laws as minimalist as possible, that we possibly should not put it into law.

As I said, 99% of complaints are completed within 12 months—that is, those that are taken on by the ombudsman. We will have to come back on Third Reading to whether the ombudsman takes on enough of the complaints that are made to them, because that issue arose in the evidence sessions of the inquiry of the Public Administration Committee into the ombudsman. If my new clauses were accepted and the ombudsman had to make an estimate of how long it would take, it is quite possible that they would simply have to tick a box to say that it would take less than 12 months. Therefore, the new clauses might, as my right hon. Friend might say, add very little but a formality. As I have said, I do not think that this reflects the way in which the health service commissioner operates. If there is an issue, she does as much as she can to keep people informed about what is happening.

The new clauses are probing amendments and, as I say, I will not die in the ditch for them. However, I look forward to hearing the views of my right hon. Friend the Member for Haltemprice and Howden, my hon. Friend the Minister and the Opposition spokesman about this minor attempt to be helpful.

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

I will give a brief response on the two proposals of the right hon. Member for North East Hampshire (Mr Arbuthnot) in new clauses 1 and 2. On Third Reading we will perhaps talk at greater length about the merits of the Bill and why it is important that we are here today. I acknowledge that these are intended to be probing amendments to provoke discussion and debate.

New clause 2 is important. We know from many of our constituents who are going through this process that it often comes at a difficult time. Any more information that they can receive about how long they should expect to wait would be helpful. We are all familiar with the card that the ombudsman already provides to us on receipt of our applications to them, so any further information that we could provide to our constituents about how long they should expect to wait would be helpful.

I see no problem with new clause 2, which seeks to provide a complainant, at the outset of an investigation, with

“an estimate of the period within which the investigation is likely to be completed.”

The key point is that it is an estimate. My only concern, although I acknowledge that the overwhelming majority of cases are completed within a year, is that we must manage the expectations of anyone who submits a complaint to the ombudsman. I reiterate that cases often come at a difficult time for people, and the concern is about complainants having to wait for months beyond the time set out by the ombudsman.

We will talk more on Third Reading about why a complaint might be brought, but we often support constituents at a time when they have had a loss or gone through a difficult medical procedure, and we know that it is important to manage expectations. Anything that we can do to provide assurance will be positive, but I do not want any period that the health service commissioner sets out to give people a false sense of security that they will receive a response within a certain time, when it could be many months after that.

I look forward to the Minister’s response, but I do not think there is much to take issue with in new clause 2 if the right hon. Member for North East Hampshire decides to press it to a Division. As I said, my only concern is about the broader provision of information to the public. I would not want to place on the health service commissioner too onerous a duty to provide a wide audience with expectations of when complaints might be responded to. We know from the commissioner that there is already an expectation that complaints will be responded to within 12 months, which is helpful, but new clause 2 would help to give people who are bringing a complaint some expectation of when it might be responded to.

[Mr Nuttall]

It is always a pleasure to follow the shadow Minister, whose remarks were pithy and straight to the point. I will try to be equally pithy in dealing with these short new clauses. I am grateful to my right hon. Friend the Member for North East Hampshire (Mr Arbuthnot) for tabling them, because they give us an opportunity to consider whether it is appropriate to include in the Bill a requirement for information to be provided to the public in general, and a complainant in particular.

New clause 1 states:

“The Health Service Commissioner shall make available to anyone considering making a complaint, an estimate of the period within which investigations are to be completed.”

Frankly, I wonder whether there is any need for the new clause. I do not want to pour cold water on my right hon. Friend’s attempts to improve the Bill, which I know are well intended, but I wonder whether he is aware of any occasion when someone has approached the commissioner and said, “I am thinking of making a complaint. Can you tell me how long you think it might be?”, and the commissioner has said, “I’m sorry, I can’t tell you that. We’re not going to tell you.” If there are a lot of people in that position, I agree that we need to address it in legislation, but I have certainly never had anybody approach me and say, “I was thinking of making a complaint, but they won’t tell me how long it will take.” I am not sure that there is a particular problem that we need to address, but I am sure that my right hon. Friend will enlighten us about that.

--- Later in debate ---

[Mr Davis]

I am not sure that the legal liability relates simply to the person bringing the complaint. It could relate to other people too, such as those contracting services. It also relates very much to reputation. Someone may, in effect, be asked to make a confession according to a timetable, which is not a good idea in a statute.

I agree with my hon. Friend the Member for Bury North (Mr Nuttall) in his critique of amendment 5. On amendment 4, I would leave that to practice guidelines, rather than putting it into law. It is dangerous, as I said earlier, to create lots of onerous responsibilities in law. The aim of the Bill is to exert pressure and give a degree of public guarantee, not to try to tell the ombudsman how to cross every t and dot every i.

The one amendment with which I felt some sympathy but am still uncertain about is amendment 3. I presumed from the Bill that the ombudsman’s department would respond close to the 12-month point when it knew that it might go past it. Earlier, it is likely to have to adjust the timetable; later is not tolerable. I am uncertain whether it may lead to perverse or unintended consequences if we do exactly what my hon. Friend the Member for Christchurch has proposed. I will have to think about that. The Bill has to go through a Lords stage. I ask my hon. Friend not to press the amendment today, but I give him an undertaking that I will look at the matter closely and see if I can come up with a form of words that I can suggest as a change in the Lords; I will let him know if I am not able to do that.

[Luciana Berger]

I shall not speak for long, but I think it right to respond to the contributions, and to speak on the options proposed by the hon. Member for Christchurch (Mr Chope). As we know, new clause 3 proposes to make it a statutory duty for complaints to be resolved within 12 months. We do not think that that is necessary. It is clear that the Bill sets out sufficient steps to achieve that. I agree with the right hon. Member for Haltemprice and Howden (Mr Davis) that, as we know, the overwhelming majority of cases are dealt with within that time, but there are obviously reasons why it may sometimes take longer. As hon. Members suggested, there may be complex cases, other agencies may be involved, or there may be a historical or long-running case that requires the extraction of data from decades past, which it may take a long time to collate. It is often not the ombudsman’s fault that these things take time. We therefore do not think it appropriate to make meeting the 12-month deadline a statutory duty.

On the amendments, it is proposed that when the ombudsman contacts complainants, she gives them an estimate of how long the investigation might take. We discussed the point earlier in relation to new clause 2. We Members of Parliament can get updates from the ombudsman on the progress of cases and share those with our constituents if they want further updates. To be fair, if we think about all the processes in which we support our constituents, this is one in which updates are provided, and complainants are provided with information about how their complaints are progressing and when an outcome might be provided.

Amendment 1 would require the commissioner to keep the complainant informed of progress. There is nothing wrong with this in principle. We should encourage the ombudsman to do this anyway. As I mentioned, as Members of Parliament supporting those complaints, we can receive updates. On the point about financial resource, I have looked closely at the amendment and listened to the debate this morning, and think that where delays occur in the progress of complaints, more often than not that is down to the complexity of the cases, rather than a lack of financial resources, so amendment 5 is not necessary. We do not believe that new clause 3 or the five amendments are necessary.

[Jane Ellison]

I understand the sentiments behind new clause 3, tabled by my hon. Friend the Member for Christchurch (Mr Chope), and each of the five amendments. I shall try to respond to some of the points that have been made, without reiterating them.

New clause 3 would place a duty on the health service ombudsman to resolve any complaint within 12 months of the date it was received, regardless of its complexity. We all have sympathy with the reason behind it, and we all want investigations by the health service ombudsman, and indeed the NHS, carried out as efficiently as possible. None the less, it would be wrong to rush cases, or to seek to put an artificial time limit on them. What is most important to us as Members acting on behalf of our constituents is that the investigation is conducted appropriately and robustly, which depends on the facts of the case. This is particularly true, as others have said, when the investigation deals with serious or complex issues.

We are all familiar with the fact that the cases investigated by the health service ombudsman generally tend to be complex and serious because they often involve an element of loss, personal tragedy, illness or disability, so they are inevitably sensitive. It is important that those investigations are conducted in a timely fashion, but on the odd occasion when they need to continue beyond the defined period, it is important that there are not artificial constraints, and that we do not constrain the handling of a complaint by focusing on the deadline, rather than the requirements of the case. That may have an unintended impact on the quality of the investigation and the complainant’s expectations about the outcome.

The Bill as drafted will hold the ombudsman more accountable for delays of over 12 months than at present, which is right, but it acknowledges that there will be some cases, albeit very few, where it is appropriate and justifiable for an investigation to take longer. Some of my right hon. and hon. Friends have alluded to the reasons for that. In other aspects of my portfolio, I have seen some of those reasons. My hon. Friend the Member for Christchurch made a working assumption throughout his comments that one reason may be delay on the part of the investigator, but sometimes it is due to other players in that investigation.

In another part of my portfolio, something extremely important has been unexpectedly delayed by the bereavement of the chief investigator. That could not have been anticipated, but it has added greatly to the delay. Cases brought to the ombudsman nearly always involve illness, and evidence may need to be taken from someone who is still ill or in recovery. It may be difficult to get that evidence, or to ask them to respond to a point made during the investigation. If the person is still suffering the effects of their illness, there may need to be an appropriate delay to allow them to recover sufficiently to give their evidence.

The Bill’s promoter, my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), made an extremely good point about expertise. Complex medical issues are rarely black and white. In a debate that has already alluded to corsets and seductions, I hesitate to speculate on the number of shades of grey that might be involved in investigations, but it is clear that they exist. Sometimes, tracking down the right expert may be not a national endeavour, but an international endeavour, if the case involves a rare illness or there is a dispute about the medical opinion. Drawing on my experience of nearly 18 months as a Health Minister, I know that that is sometimes the case and we should allow for it, because it would not benefit the investigation if we did not. For those reasons, I hope that my hon. Friend the Member for Christchurch will agree not to press the new clause, and that he will feel not that he is condoning poor or slow administration, but that he is merely accepting that some things just take longer to address.

--- Later in debate ---

[Luciana Berger]

I add my congratulations to the right hon. Member for Haltemprice and Howden (Mr Davis) on the progress of his private Member’s Bill, which contains important reforms that we support.

The measures will rebalance the complaints procedure in favour of the citizen and away from the bureaucracy. If someone feels that they have been mistreated or have been the victim of a medical accident or malpractice, they deserve swift redress. What many complainants want is a clear decision, communicated swiftly, and assurances that the medical procedures and administrative processes have changed to prevent unnecessary harm or pain from happening to someone else. In fact, only last night, I met one of my constituents who is going through the process, and their primary motivation is that no other friend or family member should experience what they have gone through.

For most complainants, it is not about financial compensation. It is about justice. When a service such as the NHS lets someone down, the injustice feels so much worse because of the high regard in which it is held. I echo the comment of the right hon. Member for North East Hampshire (Mr Arbuthnot) that we should commend the thousands of men and women who work in our national health service and do such a wonderful job on a daily basis, but there are of course occasions when things do not go right. That is why the Bill is so important.

Long delays in getting answers to complaints merely exacerbate a problem and build a sense of grievance and alienation. People feel like they will never get answers and are being strung along, and of course that is not good enough. The right hon. Member for Haltemprice and Howden should therefore be congratulated on his Bill, which is entirely straightforward and has a simple, non-partisan approach and purpose. As others have said, it has wide support throughout the health service and in the ombudsman service itself, and I hope it will have support in all parts of the House when we conclude the debate.

Anyone listening to the tragic case of little Sam Morrish, which the right hon. Gentleman outlined this morning, cannot fail to recognise that this reform is needed. As the House has heard, it took the ombudsman more than two years to investigate and report on the national health service’s handling of Sam’s case. During that time, a series of factual errors were made, which Mr and Mrs Morrish repeatedly had to correct. It is fair to say that they were let down badly by the NHS. They lost their little boy, and the process that they had to endure to seek justice and redress took too long and compounded their tragedy. They deserve every ounce of sympathy that the House is capable of offering. I hope that they are listening and hear that we really are on their side.

The Patients Association, which supported the Morrish family in their complaints, said at the time that the ombudsman was not fit for purpose. Hon. Members of all parties will have had to refer constituents’ treatment in the NHS to the Parliamentary and Health Service Ombudsman, and some of those cases—not many—will have taken a great deal of time to be processed. One thing is clear: when the ombudsman falls short, it is essential that it is open and transparent. The idea of an annual report setting out the details of how long investigations and complaints have taken to be concluded is welcome. It makes a great deal of sense, because it will allow the public to see the amount of work that the ombudsman has had to do in a 12-month period and understand why, in some cases, it has had to take longer than 12 months to reach some kind of conclusion and resolution.

The Bill’s provision on accountability to Parliament and the public is an important change. It is a small one, but it will make a great difference to the ombudsman’s work and people’s confidence in it. It is also important to note that the ombudsman welcomes the call for greater transparency and openness about its performance.

Perhaps it is worth reflecting at this point on the fact that, since the ombudsman was established in 1967 to help Parliament to hold public services to account, there have been many reforms and changes. To its credit, it has embarked on a modernisation programme since 2012, and its statutory annual report to Parliament, “A voice for change”, explains how, as a result of the first phase of that programme, it concluded six times more investigations in 2013-14 than in the previous year, completed 99% of cases within 12 months and halved the average length of investigations from 432 days to 223 days. That represents solid progress, and I congratulate the ombudsman’s staff on the work that they have done.

The reality is that there is still progress to be made, however, and I wish to press the Minister on two points, to which I hope she will be able to respond. On 31 March 2013, the ombudsman had a maximum of 30 NHS complaints that it had not concluded within 12 months. No figure was given in the annual report for 2013-14. Can the Minister share with us today, or perhaps in a letter, why there has been a delay in releasing the figure? I believe that we agree about the Bill, but I would like to hear why she thinks it will work.

I note that some have called for much wider changes to the ombudsman service—we have had an extensive debate about it over the past two and a half hours. I draw Members’ attention to the recommendations in the Public Administration Committee’s recent report, “Time for a People’s Ombudsman Service”, which included proposals for different scrutiny arrangements that would make it easier for Parliament to hold public services to account. The Cabinet Office has given a commitment to the Committee that it will carry out a review of the ombudsman landscape, and the Opposition look forward to the outcome. With the indulgence of the House, perhaps the Minister will update us on whether that review has begun and what its scope is or will be, because that will shape the way in which the Bill is introduced.

I understand that the ombudsman has now launched the second phase of its modernisation programme, focusing on what people can expect from investigations and examining the quality of its service. I understand that it will consult NHS users and patients’ groups on the development of a new service charter, which is very welcome.

The age of deference has passed, and citizens expect high standards of service, real choices and accountability from their public services. The digital revolution allows the citizen to be more informed about their medical conditions and treatments than any other generation in history. The NHS in England treats 1 million people every 36 hours, and when things go wrong, as they inevitably will in an organisation of the size and complexity of the NHS, citizens have the right to honesty, transparency and swift redress. The Bill takes some important steps in the right direction. I look forward to its being passed.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

The local Members of the Youth Parliament the right hon. Gentleman met make an incredibly important point. I refer him to the children and young people’s mental health and well-being taskforce, which will report very soon. I think that the role of schools will be crucial in its conclusions, and I encourage him to look at the report when it emerges.

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

The latest figures show a huge rise in the number of young people with a mental illness turning up at A and E. Young people not getting the help they need early on and becoming so ill that they need hospital care shows that the system is failing. Does the Minister accept that this Government’s decision to cut children’s mental health services at the same time as wasting £3 billion on a reorganisation has been a key factor in that failure?

[Norman Lamb]

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

Mental Health and Well-being of Londoners

Baroness Berger Excerpts

Thursday 12th February 2015 Commons Chamber

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

I thank my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) and the other sponsors of this debate for ensuring that the House can discuss such an important issue. I also thank hon. Members on both sides of the House for their contributions, which are testament to how much mental health is a vital challenge, not just in London but across the country.

In recent years we have seen a growing appreciation that mental health is just as important as physical health in ensuring the well-being of the population. Almost three years ago my colleagues in the House of Lords tabled amendments to the Health and Social Care Bill on parity of esteem between mental and physical health. As this debate has shown, however, there are challenges in how that measure is put into practice.

Since then, mental health has risen up the agenda as more evidence emerges not only of the scale of mental health illness, which affects one in six of us at any one time, but of the huge costs involved. In London, meeting the mental health needs of the large and diverse population poses a challenge, and it is welcome that tackling the cost of mental illness has been identified as a priority by the London Health Board. Of course the challenges are significant. In London almost £7.5 billion is spent each year addressing mental illness, while the wider health, social and economic impacts of mental illness cost the capital an estimated £26 billion.

As we heard from my hon. Friend, the pressures that mental health services face across the country are being acutely felt in London. Last week the Care Quality Commission published a report that found that last year the mental health in-patient system was again running over capacity. By the last quarter of 2013-14, the number of available mental health NHS beds had decreased by almost 8% since the first quarter of 2010-11. That is putting mental health professionals under extreme pressure, and more vulnerable people have to travel hundreds of miles to get the treatment they need, or they are getting no treatment at all.

I have had the privilege of visiting many fantastic services across the country and in London, such as the Channi Kumar perinatal unit at Bethlem Royal hospital, the Camden psychotherapy unit, and most recently the mental health service users group, the Lancaster Centre in Enfield. In response to the right hon. Member for Uxbridge and South Ruislip (Sir John Randall), I should say that I have also visited Dagenham council, which is training 1,000 front-line workers in mental health first aid. That is an example we can all learn from.

I have seen at first hand the pressures our mental health professionals are experiencing. They are working extremely hard in very challenging circumstances. I would be very interested to hear the Minister’s immediate plans to ease the pressure on in-patient mental health services in London. I think the key question we should be asking is why so many people in London need in-patient mental health care in the first place. Could it have anything to do with the fact that mental health spending has been cut in real terms for the first time in a decade? There are thousands fewer mental health nurses and hundreds fewer mental health doctors now working in the NHS. Is it because of the fragmentation of commissioning across our health service since the introduction of the Health and Social Care Act 2012?

My hon. Friend rightly talked about the pressures on child and adolescent mental health services in London. The right hon. Member for Uxbridge and South Ruislip said that we do not talk about this issue, but I challenge that. In recent weeks, we have seen front pages of newspapers covering this specific issue. I echo the concerns raised by my hon. Friend that the CAMHS budget has been cut in real terms by £50 million a year since 2010. We have seen other false economies, such as: cuts to early intervention and psychosis services; a reduction in the number of social workers; and the decimation of the early intervention grant, which we know is putting so much pressure on in-patient services.

Just today, I received a letter from the Danshell Group, an organisation that provides 20% of CAMHS provision across the country, including in London. It wrote to me because it is very concerned about the state of CAMHS, particularly in London. The contract they have been offered by NHS London for the next financial year will see a 40% reduction in the number of CAMHS beds it can offer, down from 26 to 16. NHS London has said this is because of its “financial envelope”. This reduction will have a very real impact on many young people. The provider is already forced to reject more than 30 patients every month. Its concern, which I share, is that these young people will end up in A and E, have to go to medium secure facilities if no low secure facilities are available, or be sent home because there is nothing or nowhere that can help them. This is simply unacceptable and cannot carry on.

In addition to the 50 extra beds NHS England has commissioned across the country for CAMHS, I am keen to know what steps the Minister is taking to address the bed shortage in London and across the country. The letter I received said that NHS London is going to reduce the number of beds even further. This is a very particular and significant concern. At least one in 10 children is thought to have a clinically significant mental health illness, which equates to 111,000 young people in London. The impacts of childhood psychiatric disorders cost London’s education system approximately £200 million a year. For people to be presenting at hospital, particularly to specialist mental health services, means their mental illness has usually become much more serious. Waiting until that point to address problems is not only worse but more expensive too, as it requires more specialist health care from other services.

We need more focus on prevention and promoting good mental health. The principle of prevention has long been the driving force behind public health policy for physical health, but there is no comparable body for public policy interventions for mental health. Will the Minister share with the House what actions she and her Department are taking to ensure we are doing everything we can to prevent mental illness in the first place?

My hon. Friend referred to the distinct challenges London faces, particularly in relation to mental health. I note that she uses “well-being” in the title of today’s debate. This is not all about mental illness. London has the UK’s highest proportion of the population with high levels of anxiety. Nearly half of Londoners are anxious, and almost a third report low levels of happiness. Life satisfaction and feelings of worth in London are lower than the national average.

Mental health is shaped by the environment in which we live our lives and for most people that is not in the NHS, but in our homes, communities, schools, colleges and workplaces. These institutions can help or harm mental health, sometimes quite profoundly, and this is particularly true for Londoners, who experience stark and unacceptable differences in well-being and length of life. If we can begin to address these basic and too-often-ignored problems in the capital, we can begin to unburden ourselves of both the moral and economic costs of mental ill health.

I want to deal with the issues raised by hon. Members. On poverty, insecurity and disadvantage, there is a social gradient for many types of mental health, such as depression, with those in lower income groups more likely to experience them than those in higher income groups. The incidence of mental illness varies sharply between boroughs in London, with some mental illnesses twice as common in deprived parts of London as in the least deprived. We have heard today how Government policy can be a major factor, and the National Housing Federation estimates that one in seven households affected by the bedroom tax is now at risk of eviction. Given the cross-cutting nature of these challenges, I am keen to hear what steps the Minister is taking to ensure that all Departments take mental health into account when developing policy. We are concerned that the Cabinet Sub-Committee on Public Health, which brought together all those cross-cutting Departments, no longer exists.

We are keenly aware that we are in the midst of a housing crisis, but this is particularly acute in London. In all but two of London’s 33 boroughs, at least one in 20 people are on council waiting lists, and across London as a whole more than one in 10 are on waiting lists. Behind these shocking statistics, however, are thousands of families living in overcrowded, temporary and often poor-quality private rented accommodation. The impact on family life, and the life opportunities particularly of children, is huge. My hon. Friend also referred to the spiralling costs of housing. The average rent in London is well over £1,000, which has a significant impact on many families. Poor housing, overcrowding, insecurity and lack of access to community facilities can have a harmful impact on mental health as well. Will the Minister tell us what actions she is taking nationally to ensure that health and housing needs are considered together by both service commissioners and providers?

My hon. Friend rightly raised the particular experience of the black, Asian and minority ethnic communities in London. People from BAME communities in the UK are more likely to be diagnosed with a mental illness. For example, they have a threefold increased risk of psychosis, and for black African and black Caribbean groups, this rises to a sevenfold increase. It is completely unacceptable that people from BAME groups living with mental illness are more likely to experience poor outcomes from treatment. There is so much work to be done to tackle these inequalities, particularly in a city as culturally diverse as London. What steps is the Minister taking to ensure that mental health services are culturally relevant to service users?

The previous Government’s action plan on BAME mental health, “Delivering Race Equality in Mental Health Care”, ended in 2010 and has not been renewed or replaced. We believe we need a renewed focus and leadership on tackling race inequality in our mental health services. Does the Minister have a plan for a new national strategy to tackle race inequality in our mental health services and to ensure improved outcomes for BAME communities? My hon. Friend also rightly raised the particular challenges of the lesbian, gay, bisexual, and transgender community in accessing mental health services, and I hope the Minister will address that too.

My hon. Friend the Member for Islington North (Jeremy Corbyn) raised the serious issue of the recent INQUEST report into the deaths of people in treatment or in-patient care. Anyone who saw the “Newsnight” report this week will have been very concerned, and again I would be interested to hear from the Minister about that.

[Jeremy Corbyn]

Would my hon. Friend support an investigation, on the basis of the INQUEST report, with a view to changing the regime of inspection, inquiry and appeal where there are tragic deaths in custody? She must be aware, as must the rest of the House, that many people in mental health institutions are completely alone, never get any visitors or support and are at the mercy of what we, the state, are prepared to provide and do for them.

[Luciana Berger]

I thank my hon. Friend for his important intervention, and for raising the point earlier. It is right to look at this issue. It is very clear from the report that INQUEST has outlined and provided that many serious challenges have not been addressed. Part of the challenge is that people find themselves isolated because they are placed in care and treatment, which can be hundreds of miles away from their homes, families and support structures. This means they are less likely to have visitors. Seeing the footage of one family’s experience—of their child’s in-patient care and the quality of her surroundings—was frightening. I hope that the Minister will address this specific report and share with us what the Government intend to do to look at the issue a lot more closely.

We have heard today that mental health is one of the most unaddressed health challenges of our age. Mental health services across our country are increasingly facing significant challenges, and as we have heard today these pressures are being acutely felt in London. Meeting the mental health needs of London’s population is critical to ensuring the future health and economic sustainability of the capital. In order fully to tackle these pressures, we must end the false economies and the stripping back of preventive and early intervention services that we have seen under this Government, and achieve a new focus on prevention and early intervention. I look forward to the Minister’s response.

Human Fertilisation and Embryology

Baroness Berger Excerpts

Tuesday 3rd February 2015 Commons Chamber

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

The impassioned and thoughtful contributions to the public debate that we have heard in recent weeks and months are testimony to what a sensitive and complex matter this is. Only last night, an event held in Committee Room 10 was attended by hundreds of people who are interested in the debate, and we heard representations from both sides.

On the one hand, we have celebrated the triumph of science that these new techniques represent. It is thanks to years of pioneering research by the university of Newcastle on how we can prevent the transmission of genetic mutations that we are finally reaching the point at which we can consider using these transformative techniques in humans. We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations: families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms, and who have sadly lost their children prematurely. Those families have had to face up to the risk, and perhaps the certainty, that to be a parent must come at the expense of a difficult and, in too many cases, painful life for their children. Not only would children born through such techniques be free of such conditions, but so would their children and grandchildren. This treatment would break a chain of misery that would otherwise have ruined generations of lives.

On the other hand, we are grappling with the serious ethical and moral questions that are raised by the proposed introduction of such techniques. Members have previously shared their anxiety about the uncharted territory in which we now find ourselves. The proposed regulations would make Britain the first country to legalise mitochondrial transfer, and scientists have acknowledged that there would always be a “leap of faith” the first time the technique was used.

[Robert Flello]

I think we need to dispel the myth that there will be a “first time”. This was done more than a decade ago. In its recent analysis, the HFEA ignored the Zhang study. The Minister is shaking her head. She has clearly not read the study, which showed that when the technique was first tried, triplets were conceived. One was terminated almost immediately—within 30 days—and, of the other two, one was stillborn and the other died as a result of miscarriage. That is the reality. This is not groundbreaking; it has been done before.

[Luciana Berger]

I shall be dealing with the expert panel reviews that have been conducted since the date to which my hon. Friend has referred.

It is right that we have had a chance to hear all the arguments and to give them full and proper consideration, but it is critical to the integrity of the decision that is eventually reached for the debate to be based on the facts. When debating matters such as this, we will naturally hear a number of contradictory assertions. I am sure that the Minister will reassure the House about any further issues that are raised during the debate.

[Mr Donohoe]

May I ask the shadow Minister a simple question? Is this a case of DNA being genetically modified?

[Luciana Berger]

I do not believe that that is what is being proposed, but I shall deal with my hon. Friend’s very specific point later in my speech.

[Richard Drax (South Dorset) (Con)]

I know from a meeting that I attended before the debate that the HFEA has said, “PNT involves genetically modifying a human embryo”.

[Luciana Berger]

That point was raised in an earlier intervention. I think it is clear from reports following reviews by the expert panel that it has already been specifically addressed, but I shall deal with it in more detail later.

[Dr Julian Huppert (Cambridge) (LD)]

There seems to be a lot of confusion between nuclear DNA and mitochondrial DNA. It might help the hon. Lady and the House if I point out that they have completely different origins. They have a different genetic code; they are not related. The origin of mitochondria is bacteria that were engulfed by cells. They are very different. The House should be aware of that.

[Luciana Berger]

I thank the hon. Gentleman for that clarification.

Many concerns have been raised, the first of which is that this process is being rushed through. Anyone who has been involved in the development of these techniques would disagree that this has moved quickly. Professor Doug Turnbull and his team at the university of Newcastle have been researching this for 15 years. It was over six years ago, back in 2008, that the Human Fertilisation and Embryology Act 1990 was amended to introduce the powers to allow regulations that would enable mitochondria replacement to take place to be brought forward. It was back in 2010 that researchers at the university of Newcastle developed the techniques to avoid diseased mitochondria being passed from a mother to her children. After another three years of consultation and review processes, the Government announced in July this year that they would be bringing forward the regulations to enable mitochondrial donation techniques to be used, and that is what we are voting on today.

[Guy Opperman (Hexham) (Con)]

The hon. Lady and I both attended the meeting last night, which was very productive and helpful. Does she agree that this is about choice for the families? I have constituents who have this particular disease and constituents who work at Newcastle university, and what we are trying to do is provide a scientific way forward, under a highly structured and licensed regime, to alleviate these particular families’ suffering.

--- Later in debate ---

[Luciana Berger]

I thank the hon. Gentleman for that intervention. It was clear last night when we heard from the affected families that they wanted that choice, and these regulations very specifically only apply to those families that are affected by mitochondrial disease.

[Mr Peter Bone (Wellingborough) (Con)]

Will the hon. Lady give way?

[Luciana Berger]

I am going to finish my point, if I may.

In the intervening years the science and ethics of these techniques have been extensively debated. The Nuffield Council on Bioethics and the HFEA held extensive public consultations in 2012 and identified broad public support for the use of these techniques. There have been three expert scientific review panels—in April 2011, March 2013 and June 2014—all of which found no evidence to suggest that the techniques are unsafe for clinical use, and only last week a group of eminent scientists and experts in medical ethics, including Professor Sir John Sulston, Baroness Warnock and Sir Paul Nurse, wrote to The Times urging Parliament to approve the new regulations. They argued that the question parliamentarians must consider is not whether we would want to use this technique ourselves, but whether there are grounds to prevent affected families from doing so. I again reiterate what we have heard in the representations from families, and particularly women of child-bearing age: they want the opportunity to use these techniques.

[Mr Bone]

The hon. Lady is making a very good speech and is trying to make it balanced. She talked about last night’s meeting, which I understand went on for quite some time, and there has been a lot of debate outside this Chamber, but is she satisfied that we come here to the Chamber this afternoon with only 90 minutes to discuss this? Would it not be better if we were to withdraw this motion today and come back with more time to debate it next week?

[Luciana Berger]

Unfortunately, it is not in the Opposition’s gift to determine the time allocated for these debates. I would have welcomed further debate, and we had an opportunity in a previous Backbench Business Committee-initiated debate to discuss these matters.

[Dr William McCrea]

Will the hon. Lady give way?

[Luciana Berger]

I am going to make some progress, because I am conscious—referring back to the intervention of the hon. Member for Wellingborough (Mr Bone)—that we have limited time and many Back Benchers wish to contribute.

It is important to note that the use of these techniques will not be rushed into lightly if Parliament does pass them today, and specialist clinicians will then have to obtain a licence from the HFEA to use the techniques. We heard last night that this will only be in centres of excellence, and the HFEA will consider applications on a case-by-case basis.

We have heard concerns in previous debates that allowing mitochondrial donation is a dangerous road to start down, and that it could potentially lead to designer babies and parents being able to select the physical characteristics of their children. But we have also heard in the public debate that these fears do not take into account the fact that these regulations are very specific and cover only mitochondrial DNA, not the nuclear DNA that determine our physical characteristics. The legislation only permits the use of these techniques in the clearly defined situation of incurable mitochondrial disorders.

The fact that these techniques apply only to the mitochondrial DNA and not to nuclear DNA should provide further reassurance to those Members concerned that this process would result in “three-parent babies.” As we have heard, mitochondrial DNA only controls mitochondrial function and energy production. Importantly, nuclear DNA, which makes us who we are and determines appearance and personality, will not be altered by the techniques that we are discussing today.

The regulations clarify that a mitochondrial donor is not to be treated as a parent, by contrast with the legal position for sperm and egg donors, who are treated as people who would, or might, be the legal parent of a child born from their donation.

There are questions around the safety of these techniques. As we have heard, this technique has received unprecedented scrutiny by the HFEA’s specially convened expert scientific review panel. However, it is possible that side effects could emerge over time and scientists have acknowledged that there would always have to be a “leap of faith” the first time the technique is used in humans.

[Sir Edward Leigh (Gainsborough) (Con)]

On the question of safety, does the hon. Lady not consider it significant that the Food and Drug Administration in the United States said that it was not clear that the scientific procedures were effective and safe? The FDA, of course, refused to allow the use of Thalidomide while we did, and the rest, as they say, is history.

[Luciana Berger]

I understand that the FDA has written to the British press in the course of the last week to contradict that position. There is a very different political situation in the US, and there is a very different set-up there in terms of the FDA compared with here and what we are discussing today.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

Does my hon. Friend agree that the fact is that any scientist would say that no technique is entirely safe but the risk in this case is very low indeed, and completely justifies the leap of faith she describes, which is in effect a further advance in the use of IVF technology—which itself was pioneered as a leap of faith in 1978?

[Luciana Berger]

My hon. Friend makes some very important points, particularly about the assessment of risk, which has been done extensively throughout this process.

The question is whether the benefits of preventing the transmission of mitochondrial disease, and the likelihood that children will continue to be born who will die in infancy, outweighs the risks of the techniques. The scientific community and the families experiencing mitochondrial disease say that they do; and according to research, almost 2,500 women in Britain of child-bearing age are at risk of passing the condition on to their children. It is now up to Members to decide whether they agree.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I am most grateful to the hon. Lady for setting out a balanced case. Can she clear something up for me? I understand that there are two sources of mitochondrial disease: the DNA in the nucleus as well as the mitochondrial DNA. Can she confirm that mitochondrial disease from the nuclear DNA will remain in our population even after this treatment is licensed?

[Luciana Berger]

I hope the Minister might be able to address that in her response to the debate, with the support of her officials. It is not something I have been made aware of, and it certainly has not come up in any of the discussions or debates that I have attended.

I will now conclude, as I know that many Members wish to contribute. The research has been done, the reviews carried out and the experts and the public have been consulted. Time is precious for those parents at risk of passing on mitochondrial inherited disease to their children, and I believe that we must not delay any further.

[Several hon. Members]

rose—

Child and Adolescent Mental Health Services

Baroness Berger Excerpts

Monday 2nd February 2015 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the availability of child and adolescent mental health in-patient beds, and on child and adolescent mental health services more generally.

[The Minister of State, Department of Health (Norman Lamb)]

Since April 2013, NHS England has been responsible for commissioning in-patient child and adolescent mental health services—CAMHS—often referred to as tier 4 CAMHS. In 2014, NHS England reviewed in-patient tier 4 CAMHS and found that the number of NHS-funded beds had increased from 844 in 1999 to 1,128 in 2006. That has now risen to more than 1,400 beds, the highest this has ever been. These data are now being collected nationally for the first time, but despite the overall increase, NHS England also found relative shortages in the south-west and areas such as Yorkshire and Humber.

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases.

National availability of in-patient CAMHS beds is reviewed each week by NHS England specialised area commissioning teams and the national lead for commissioning, identifying any issues and taking proactive steps to address them. On 30 January, it emerged that the number of general CAMHS beds available was lower than in recent weeks. In response, NHS England implemented contingency plans, including contacting existing CAMHS providers to seek additional capacity and increasing the use of intensive home support packages to allow children and young people to be treated at home or on a non-specialised ward. NHS England has also contacted mental health providers to alert them to the immediate capacity issues in CAMHS and establish what capacity existed in adult in-patient and community services to take cases on a temporary basis, should that option be required.

The Government are committed to improving CAMHS as part of our commitment to achieving parity of esteem between mental and physical health—this is not just for in-patient services, but for services in the community, and for services that seek to intervene early and prevent problems arising. That, ultimately, is where the focus must be to ensure that, as far as possible, we spot issues early and prevent them from worsening, reducing the need for in-patient treatment.

In August 2014, the Department of Health set up the child and adolescent mental health and well-being taskforce. The taskforce brings together a range of experts from across health, social care and education. It will consider how we can provide more joined-up and accessible services built around the needs of children, young people and their families. A Government report on the taskforce’s findings will be published in the spring.

The Government have also invested £54 million in the children and young people’s improving access to psychological therapies programme and will invest £150 million over the next five years in improving services for those with eating disorders.

[Luciana Berger]

All over England, our child and adolescent mental health services are increasingly under pressure. Despite the best efforts of NHS staff, the system is now in crisis. Children are being sent hundreds of miles for treatment or detained in police cells because there is nowhere else for them to go. We are also hearing of young people getting no treatment at all. I was appalled to see the copy of the e-mail that NHS England commissioners sent on Friday night, warning mental health trusts of a national shortage of in-patient beds for children. It was almost one year ago that the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. Why did the Minister not act on that warning and do something to prevent it from happening?

The e-mail from NHS England said that the shortage would make it likely that 16 to 18-year-olds would need to be admitted to adult wards. Senior inspectors at the Care Quality Commission say that under-18s should not be put on adult wards, so why is NHS England issuing guidance that contravenes that advice? Adult mental health wards are no place for young people, but how can the Minister be sure that even in emergencies adult wards can accommodate children and teenagers? Adult mental health wards are operating at well over their recommended capacity, and today the Royal College of Psychiatrists has warned that the lack of acute beds available to mental health patients has left the system at breaking point. If adult mental health wards are full, where will these children go? What assessment was used to determine how many beds were needed? Clearly, it is not working. Does the Minister now plan to reassess the situation?

Why are so many of our children and young people needing in-patient mental health care in the first place? Could it have anything to do with the £50 million of cuts to child and adolescent mental health services? The Minister talked about early intervention, but we have seen cuts to early intervention in psychosis services, cuts to crisis services in the community, and the decimation of the early intervention grant, putting a lot of pressure on in-patient services. Could the problem be the fragmentation of commissioning we have seen across the health service since the Government’s reorganisation of the NHS?

The Government have paid lip service to parity of esteem and brought cuts and crisis in reality. Our children deserve better, and that is why Labour is committed to working to reverse the damage done to child and adolescent mental health services by this Government and why we have pledged to end the scandal of the neglect of child mental health.

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

Blood Safety (Variant Creutzfeldt-Jakob Disease)

Baroness Berger Excerpts

Thursday 29th January 2015 Westminster Hall

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

It is a pleasure, as always, to serve under your chairmanship, Sir David. I thank the Chair of the Select Committee on Science and Technology, my hon. Friend the Member for Ellesmere Port and Neston (Andrew Miller), and the other Committee members for their extremely thorough and valuable report, and for ensuring that we have the opportunity to debate this important issue.

I think that we all agree that variant Creutzfeldt-Jakob disease is a deadly illness around which many uncertainties remain. The report “After the Storm?”, the Government’s response and this debate are welcome contributions to parliamentary and public understanding of vCJD, transfusion and prion diseases, and the Government’s action in response to those risks.

The history of blood transfusion in this country is impressive and important. The principle of freely given, unremunerated blood donation operating within the NHS, free of commercial considerations, has served this country well. It was Richard Titmuss who famously described that arrangement as “the gift relationship” and blood as

“a bond that links all men and women in the world so closely and intimately that every difference of colour, religious belief and cultural heritage is insignificant beside it.”

We have come a long way since the UK’s first voluntary blood service was founded by the British Red Cross to help the treatment of servicemen in 1921. Today, approximately 2.2 million whole blood product donations are made in the UK each year and screened for a variety of different pathogens. Those donations are tested, processed and distributed by one of the country’s four blood services. The success of the system hinges on an assurance of the very highest level of safety and risk avoidance. Sometimes, an element of honesty is important on the part of the potential donor, but even more important are procedures to protect recipients of blood and blood products from risk. We should be proud that our UK blood supply has been proven to be extremely safe. In the vast majority of cases, the benefits of receiving a transfusion far outweigh the risk of acquiring a transfusion-transmitted infection.

Sadly, however, we have reached that point only after significant tragedy. Last week, the House debated a report by the all-party group on haemophilia and contaminated blood that looked at support for the thousands of haemophiliacs who were treated with blood that carried the hepatitis C virus in the 1970s and ’80s. In the ’80s and early ‘90s, contamination of the UK blood supply with HIV led to a further 1,200 infections. Since those tragedies, all UK blood donations have been tested for HIV and hepatitis C. Those experiences are relevant to this debate, because the safety measures were implemented only after those mass infection events.

The report “After the storm?” makes a helpful distinction between the known risks that can be well mitigated and the known risks that cannot. Our existing blood safety measures are largely focused on the known risks that we can easily mitigate through measures such as testing and screening. Unfortunately, as we have heard, prions, which are responsible for variant CJD, are invulnerable to those methods, so we need to develop new ways to mitigate those risks. The key question that we have debated today is how far the Government should prioritise such research and development.

It is extremely difficult to draw conclusions, because so many uncertainties remain. However, there are several things that we know. Although it is extremely rare, variant CJD is invariably fatal, and most people die within a year of first experiencing symptoms. Recent studies indicate that tens of thousands of people in the UK could be silent carriers of the prions responsible for the disease, and they may transmit those prions to others. Cases of transfusion-transmitted variant CJD are known to have occurred although, as has been pointed out, that happened 15 years ago. The Government have acknowledged that risk.

Currently we do not use a test to detect the presence of prions, but there are emerging technologies that could mitigate the risk, such as prion filtration and the prototype variant CJD blood test. It is natural to hope that the Government will adopt a precautionary approach and support the development and introduction of technologies that have the potential to mitigate those risks. The report “After the storm?” makes concerning reading in that regard. I take on board the Government’s response that they have not reduced any of the significant steps taken since the late 1990s to reduce the potential for secondary transmission. It is also welcome that the Department continues to allocate its only ring-fenced research budget to research related to prion disease, but the question is whether that is sufficient. In her covering letter to the Government’s response to the report, the Minister wrote:

“There are competing research priorities for our limited funding”.

That must be true, but surely there can be no greater priority than assuring the safety of patients receiving blood transfusions.

The Science and Technology Committee examined several possible technologies that might be developed to militate against the transfusion of variant CJD, and I will discuss some of them briefly. The Chair of the Science and Technology Committee, like the hon. Member for Mole Valley (Sir Paul Beresford) and my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), spoke about those technologies, but I have further questions about them for the Minister. The development of a test for the presence of the prion is of enormous importance, given that data suggest that the prevalence of sub-clinical disease and infection may be as high as one in 2,000 people. Although this is disappointing, I appreciate that the Government may not be in a position to commit to a prevalence test yet. It is welcome that they have committed to seeking the views of the transmissible spongiform encephalopathy sub-group of the Advisory Committee on Dangerous Pathogens on the scientific and technical issues involved in developing such a test and on the potential value of a blood prevalence study. I would welcome an update from the Minister on how that work is progressing and when the Government will be in a position to make a decision about the value of a prevalence study.

The report examined ways to mitigate the risk of transmission of prions by surgical instruments and the Committee expressed concern about the implementation of guidance on the decontamination of surgical instruments. It is indeed alarming that such concerns exist. As we have heard from the Committee Chair and the hon. Member for Mole Valley, it should be part of local clinical governance arrangements that such a fundamental patient issue should dealt with, reviewed routinely and reported to the board of the trust.

The Government stated in their response to the very reasonable recommendation of the Science and Technology Committee:

“Accordingly, the Department will discuss with the CQC the need for the implementation of decontamination guidance to be addressed in its regulatory activity”.

I find that use of the word “discuss” a matter for concern. Decontamination should be mandated, inspected and assured. Patients might find it worrying that all the Department of Health is prepared to do is to “discuss” with the CQC the need for action on the matter. I would be grateful for the Minister’s assurance that the proper sterilisation of medical instruments will be dealt with as a matter of urgency.

[Sir Paul Beresford]

To be fair, I think that the hon. Lady should recognise that the RelyOn is not in a state in which it can be simply used. It is a wash, but if the opportunity were there, it might well be developed for the market so that it could be put into washer-disinfectors. I think that that is perhaps what the discussion is about.

[Luciana Berger]

I thank the hon. Gentleman and hope that the Minister will deal with that point. She could perhaps directly task the newly appointed regional public health directors of Public Health England to review instrument sterilisation in all trusts and report directly to her on the matter.

Prion filtration is another possible method of mitigating the risk of transmission of variant CJD. That is the process through which prions are physically removed from blood through the use of highly specific resin ligands. After recommending the use of the technique in 2009, the Advisory Committee on the Safety of Blood, Tissues and Organs decided in 2012 to rescind its initial recommendation, so prion filtration has not been adopted in the UK. The scientific decision making of the committee must of course be respected, so I do not seek to challenge its decision, but the Select Committee’s report raises important questions about the process that is followed through such reviews, and makes some important recommendations.

The report recommends, for example, that the health technology appraisals conducted by the advisory committee should use the same methodology and meet the same high standards as those undertaken by NICE, the UK’s centre of excellence for that activity. The Government have said that work to explore the differences in appraisal methodology between NICE and other health-related bodies, including the Advisory Committee on the Safety of Blood, Tissues and Organs, is being carried out through an appraisal alignment working group. I reiterate the question asked by my hon. Friend the Member for Ellesmere Port and Neston: will the Minister please give us an update on how the work is progressing and when the group will report?

The “After the storm?” report raised concerns that the scientific advisory committees are not currently independent of the bodies to which they provide advice. In response, the Government also said that they would review the terms of reference of the Advisory Committee on the Safety of Blood, Tissues and Organs and ensure that they are clarified appropriately. They said that the advisory committee is planning to amend its code of practice so that future working groups and sub-groups will not be chaired by someone who holds a senior policy-making position in an organisation if the topic under consideration relates directly to that organisation’s interests or activities. Has that work now been completed?

We should all agree that protecting the public from potential harm by transmission of the prion that causes variant CJD—or, indeed, from the transmission of any serious threat to health via our blood service—should be given the highest priority. The Science and Technology Committee has raised valid concerns that some recent Government decisions signal a change from the precautionary approach to variant CJD risk reduction of the late 1990s to a more relaxed approach today. As we have heard, significant questions remain, so I look forward to the Minister’s response.

NHS (Government Spending)

Baroness Berger Excerpts

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.

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

It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?

[Dr Poulter]

Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.

We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.

At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.

The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

As my right hon. Friend will be aware, the funding formula is now reviewed regularly. That is done independently and is free from political interference. Looking at areas such as hers, where there are a lot of frail and elderly patients, is now more paramount in the funding formula. In the future, I am sure that the funding formula will better reflect local health care needs.

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

One in four patients now wait a week or longer to see a GP. Last week’s official NHS survey revealed that almost 1 million people had to turn to A and E because they could not get a GP appointment. Will the Minister accept that his Government have made it harder to see a GP, and have caused the A and E crisis in the process? Will he respond to Labour’s call for GPs to be placed in major A and Es to help ease the pressure?

[Dr Poulter]

I do not think that people wanting to see their GP was at all helped by the previous Labour Government’s disastrous decision to contract out the GP out-of-hours service. Many patients are now struggling to receive appointments in the evenings and at weekends. The previous Government also broke the link with family doctors. To reassure the hon. Lady, the latest GP patient survey results suggest that less than 2% of patients who want GP appointments have to resort to walk-in centres or A and E departments. Under this Government, we have put in place an extra 1,000 GPs.