Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

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

The report on the appalling failures at Southern Health NHS Foundation Trust highlighted the fact that more than 1,000 unexpected deaths of mental health and learning disability patients, many of which took place outside hospital, had not been investigated. Given that the Health Secretary did not allow the House an opportunity to scrutinise those findings before Christmas, will he or the Minister respond today to the widely held concern that the experience of that NHS trust is not an isolated one? Does the Minister agree that a national public investigation is now needed?

Mental Health

Baroness Berger Excerpts

Wednesday 9th December 2015 Commons Chamber

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

I beg to move,

That this House believes that mental health should be treated with the same priority as physical health and recognises the importance of promoting good mental health from childhood through to adulthood; believes that not enough progress has been made in translating this House’s commitment to parity of esteem between mental and physical health into practice; notes with concern that the King’s Fund has reported widespread evidence of poor-quality care across mental health services, and the latest available figures show a rise in suicide rates and the number of detentions under the Mental Health Act 1983 increasing by 10 per cent in the past year alone; further notes the delay in the publication of NHS England’s Mental Health Taskforce report; notes the concerns that have been raised with the Scottish Government regarding the rate of inappropriate admissions of young people to non-specialist facilities for mental health treatment which have increased by 38 per cent since 2011; is concerned by the absence of data on NHS spending on mental health services since 2011-12; opposes the Government’s decision not to enshrine the right to psychological therapies in the NHS Constitution; and calls on the Government to urgently rectify this systemic inequity in entitlement to treatments, reinstate the annual survey of investment in mental health services and develop and implement in full a new strategy to improve the Government’s cross-departmental response to mental health.

It is a privilege to open this debate as the first shadow Minister for mental health. The fact that we are having this debate is testament to just how seriously the Opposition consider mental health. The issue affects one in four of us every year, yet it has been neglected for far too long. Mental health has come out of the shadows in recent years, and I know that many Members on both sides of the House feel very strongly about this issue. There have been many important steps forward, but talk to anyone with a mental health condition and they will tell you that they still face stigma, prejudice and discrimination. Sadly, there remain many areas in which there has not been the progress for which we had hoped.

Labour Members have deep concerns about our nation’s mental health and the services and support that are available. Three years ago, my Labour colleagues in the House of Lords won the fight to ensure that the Government wrote parity of esteem between mental health and physical health into law. However, the gap between the rhetoric we hear from this Government and the reality for patients on the ground is growing wider.

I am sure Members on both sides of the House have many constituency cases that echo such concerns. In my first few months in this position, I have been struck by the thousands of messages I have received from people up and down the country. They are desperate to see a change in how our society approaches mental health. This strength of feeling is not surprising. On this Government’s watch, there has been an increase in the number of patients who report a poor experience of community mental health care. More patients have to travel hundreds of miles just to get a bed. The number of children being treated on adult wards, which the Mental Health Act 1983 rightly says should not happen, has risen again this year. The number of people becoming so ill that they had to be detained under the Mental Health Acts leapt by 10% in the past year. The level of suicides, particularly among men under the age of 45, has been at its highest since 2001.

[Ms Karen Buck (Westminster North) (Lab)]

Does my hon. Friend share my concern about the scale of the stress—by common agreement, often inappropriate stress—on the police as a consequence of the pressure on emergency mental health services? My local police have advised me that they sometimes spend half a shift with severely mentally ill patients who are queuing for access to acute mental health hospitals. That is bad for the police and bad for the patients, and is a reflection of the terrible pressures on the acute mental health sector.

[Luciana Berger]

I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.

[Norman Lamb (North Norfolk) (LD)]

I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.

[Luciana Berger]

I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.

I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.

[Paul Blomfield (Sheffield Central) (Lab)]

My hon. Friend is making an important point about the transparency of spending. Last June, I asked the then Health Minister, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, when figures would be published, and he told me that the Government were working with NHS England to provide meaningful data. Last month, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tabled a question for written answer asking when the information would be available. It is still not available. Does my hon. Friend agree that the Government should come clean?

[Luciana Berger]

I thank my hon. Friend for his very important intervention. One of the key points of my speech is that there is so much we should do to shine a spotlight on what is happening to mental health funding right across the country.

[David Rutley (Macclesfield) (Con)]

The hon. Lady is of course right that this subject is vital. The Government are working hard on it. Will she join me in welcoming the Government’s promise and commitment to bringing in an extra £600 million for mental health services, as set out in the autumn statement?

[Luciana Berger]

My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.

[Mr Robin Walker (Worcester) (Con)]

rose—

[Luciana Berger]

I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.

We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.

[Helen Whately (Faversham and Mid Kent) (Con)]

Does the hon. Lady agree that transparency is known to be a very effective lever for the Government to use to improve quality? Does she welcome the steps taken by the Government to increase transparency in the performance of mental health services?

[Luciana Berger]

I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech. On prevention, is she as concerned as I am that a recent report by the University of Liverpool has estimated that an additional 590 suicides were associated with the work capability assessment process, a Government policy, between 2010 and 2013?

[Luciana Berger]

I am fully aware of the research that my hon. Friend mentions. It was carried out by a number of academics from the University of Liverpool, including one of my constituents. I have studied the research very carefully. It highlights many areas of concern, particularly the changes and reforms made by the Department for Work and Pensions that have had a negative impact. I will address the very point she raises later in my remarks.

Nowhere is this gap between Ministers’ rhetoric and the reality more evident than when we look at investment in our mental health services. Only last year, funding for mental health trusts was cut by 20% more than that for other hospitals. In 2011-12, total investment in mental health dropped for the first time in a decade. Perhaps unsurprisingly, in the same year the Government stopped publishing how much they invest in mental health.

Last year, I had to use freedom of information requests to get to the bottom of how much clinical commissioning groups were allocating to mental health: 67% of those who responded spent less than 10% of their budget on mental health, despite the fact that mental health accounts for 23% of the total burden of disease. This year, the Minister for Community and Social Care promised to do something about this. He said he would ensure that investment in mental health by clinical commissioning groups increased in this financial year in line with the increase in their overall budgets. However, as the Government do not publish a central record of these data, I had to use the Freedom of Information Act to find out for myself. Over the past summer, I found that more than one in three CCGs were not meeting the Government’s expectation. That is just one of many Government pledges on mental health that have not been translated into reality.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

The hon. Lady is making an important speech, but may I encourage her to be as bipartisan or as all-party in her approach as possible on this vital issue? It is very good to see the Leader of the Opposition and the Heath Secretary in their places, both of whom have a long-standing interest in this issue. Will the hon. Lady at least accept that the all-party campaign led by the right hon. Member for North Norfolk (Norman Lamb)—very substantially assisted by Alastair Campbell, who has some considerable expertise in this area—was successful, beyond the scenes, in persuading the Chancellor to produce an extra £600 million for mental health? All of us will try to ensure that that money is spent well, but let us try to do so with an all-party or bipartisan approach.

[Luciana Berger]

I know that the right hon. Gentleman has worked hard on these issues, as have many Members across the House. My job is to hold the Government to account for the promises they have made, and that is what I am endeavouring to do. Where there are opportunities for us to work together we should be keen for that to happen, but the Government have not delivered on their previous pledges. I am keen to know the detail of how that £600 million will be allocated and over what period, and we look forward to that information coming forward.

The spend of clinical commissioning groups is just one pledge on mental health that has not translated into reality, and—unfortunately—another is the commitment to spending £250 million on child and adolescent mental health services this year. In response to a parliamentary question, the Government have admitted that there will be a £77 million shortfall on what they have pledged to spend this year. With those spending promises so far unfulfilled, Labour Members are concerned about the lack of transparency on mental health spending. That is why we are calling on the Government to reinstate the annual survey of investment in mental health services.

It is not only in funding that equality for mental health has yet to be achieved, because a huge disparity remains at the heart of our NHS. The NHS constitution sets out the rights to which patients, the public and staff are entitled, and the pledges that the NHS is committed to achieving. The constitution enshrines our rights to access drugs and other treatments, but it does not extend that right to talking therapies. Recently, the Government consulted on adding a right to psychological therapies to the NHS constitution, but they decided not to include it in its latest version. That decision reinforces the existing bias in the system against mental health, and if the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

I am disappointed with the tribal attacks on the Scottish health service in the motion, and it does not say much for the new politics promised by the Leader of the Opposition. Has the hon. Lady reflected on the situation in Wales—the only part of the UK where the Labour party is in charge—because the Academy of Medical Royal Colleges in Wales, which represents 16 colleges and facilities, said last month that mental health services in my country face significant inequalities? How will the hon. Lady respond to those concerns?

[Luciana Berger]

I have heard from my colleagues in Scotland about the challenges that they face with mental health services, and it is right that we should raise that issue during this debate. I have also had the opportunity to meet my colleagues in Wales and see the fantastic work that they are doing. Their pioneering piece of mental health legislation, which came into force in 2012, is the first for any developed country in terms of how it treats mental health, and it ensures that patients have a proper dedicated plan that considers not only their health needs, but their support, personal care, wellbeing, education and training. I look forward to working with my colleagues in Wales and to supporting them in the fantastic work that they are doing.

[Mr Ivan Lewis (Bury South) (Lab)]

My hon. Friend made an important point about access to talking therapies. One of the biggest consequences of not having such access is the fact that the only option available to clinicians is medication—often in very inappropriate circumstances—which can lead to people becoming dependent, sometimes for a long period of time. This is not just a minor matter about whether this provision is in the constitution; that lack of access leads to inappropriate intervention that can have a lifelong effect on many people.

[Luciana Berger]

I thank my hon. Friend for his important intervention. I am sure that too many of us hear from our constituents about how that sort of experience has been replicated across the country. We know that the number of prescriptions issued for mental health issues has risen exponentially and is into the millions for people who have to access drugs. Sometimes that is because they cannot access talking therapies, which should be of serious concern to us all.

[Lucy Frazer (South East Cambridgeshire) (Con)]

Does the hon. Lady welcome the Government’s commitment to introducing waiting time standards so that patients do not have to wait a long time to get access to a talking therapy? This Government introduced that measure, but the Labour Government did not.

[Luciana Berger]

The Labour Government created the services in the first place. In order to introduce a waiting time standard those services have to exist, which was not the case previously. We had to address the chronic underfunding of mental health that existed pre-1997, and we introduced the improving access to psychological therapies programme, of which we are incredibly proud. As things develop, it is right that those waiting time standards come forward. The Labour party had waiting time standards in place for all consultant-led services, which included physical and mental health. I am proud of that fact but disappointed that in too many cases the same equality is not also applied to mental health. If the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity. That is why we are calling on the Government to commit to ensuring that all patients, regardless of whether they need a drug, a physical health treatment or a psychological therapy, have the same rights.

[James Morris (Halesowen and Rowley Regis) (Con)]

rose—

[Luciana Berger]

I hope the hon. Gentleman will forgive me but I will make some progress as I am conscious of time.

Ensuring that people have access to help early on is critical to preventing people from becoming ill, but in recent years, short-sighted cuts to key prevention, early intervention, and community services have been having a devastating impact. When the number of children with a mental health problem who turn up at A and E has doubled in recent years, when one person in prison takes their own life every four days, when a young person who is self-harming is told that because they are not suicidal they do not meet the threshold for help, and when a woman with an eating disorder is turned away from specialist services because her body mass index is not low enough, it is clear that people are not getting the right help early enough.

Too often, mental health problems are ignored, and it is only when they reach crisis point that they receive attention. More and more I hear from mental health professionals across the country that their middle-tier community services, psychologists and counsellors are being stripped out. Apart from the obvious devastating human cost, which impacts on people’s ability to hold down a job, keep a tenancy, pay the mortgage and maintain relationships with partners, friends and family, those decisions will cost our NHS and local authorities more as they struggle to deal with the consequences of serious ill health that could have been prevented. That cost is not insignificant. Recent studies have put the cost of mental ill health to our society at a staggering £105 billion a year. How can the Secretary of State and this Tory Government justify that? Ensuring that people can access support when they need it is an urgent priority, but if we are to ensure that our services are sustainable into the future, we must do much more to prevent people from becoming ill in the first place.

The right hon. Member for North Norfolk (Norman Lamb) mentioned perinatal mental health problems, which affect up to 20% of women at some point during pregnancy and/or the year after the birth of their baby. Left untreated, perinatal mental health problems cost our economy £8 billion a year. Is it not appalling that even if those women seek help, they are not always guaranteed the specialist support they need? The number of mother and baby units has dropped since 2010. The Government’s pledge to spend £15 million on perinatal mental health this year was welcome, but as of this month— according to an answer I received to a parliamentary question—the Government have spent just one fifteenth of what they promised. That is a bitter disappointment because intervening early in perinatal mental health does not just help to improve the health and wellbeing of the mothers affected, but it also improves that of their children.

[James Morris]

May I take the hon. Lady back to her point about the IAPT programme that was introduced by the previous Labour Government and is an illustration of where both parties have delivered success? It may be good to enshrine psychological therapies in the NHS constitution, but we need to build more capacity in the system to deliver on access standards. This is not something that we can just write into the constitution; we need to increase choice and access to psychological therapies across the country.

[Luciana Berger]

I do not think it is an either/or situation; it is about how we do both, and I will come on to that in the rest of my remarks.

We know that 75% of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, yet only about 6% of the mental health budget is spent on child and adolescent mental health services. We need to do more to focus attention on children, young people and, crucially, prevention, and here we must look to our places of learning, our workplaces and our communities. We need schools and colleges that promote good mental health. We need to ensure that all children have access to high-quality social and emotional learning so that they acquire the skills to express how they feel and develop an understanding and awareness of good mental health. We were concerned to read the 2013 Ofsted report on personal, social, health and economic education, which stated that mental health education was often omitted from the curriculum owing to a lack of teacher training. The Government have funded the PSHE Association to publish guidance and lesson plans to support teaching about mental health, but how are the Government ensuring that schools are actually using it?

We need communities that promote good health and wellbeing. Poor housing, fuel poverty and neighbourhood factors, such as overcrowding, feeling unsafe and a lack of access to community facilities, can have a harmful impact on mental health. These, along with abuse, bullying, trauma, deprivation and isolation, are just some of the levers of mental distress in our communities that we must address.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on setting out such a strong case. Does she agree that the pressure on local government over the last few years has had a negative impact on community cohesion in relation to mental health and led to a growth in loneliness and other such things that spawn mental health problems?

[Luciana Berger]

My hon. Friend’s intervention brings me neatly on to my next remarks. I am enormously concerned about the impact of the Government’s deep cuts to local authority budgets over the past five years, of the additional £200 million in-year cuts to public health and of the cuts coming further down the line. I am concerned about their impact on our communities and the services that serve them, such as our libraries, drop-in centres, leisure centres, befriending services—my hon. Friend talked about loneliness—children’s centres, which support parents and young children, and citizens advice bureaux, which support people early on. They are the glue that support and keep our communities together, and I am concerned about what might happen over the next few years.

We need a social care system that is integrated with our physical and mental health services, and we will continue to push the Government to address the fragmentation across these systems. Billions have been slashed from social care budgets and the number of people receiving social care support for mental health has fallen by a quarter since 2009-10. This is seriously impacting on mental health trusts’ ability to discharge their patients. I hear that time and again when I visit mental health trusts across the country. They have patients they cannot move out because the social care is not available for them to move into.

We need workplaces that promote a good work-life balance and where mental health is recognised, understood and supported. Some 70 million working days are lost every year owing to stress, depression and other mental health conditions. Mental health problems cost employers in the UK £30 billion a year through lost production, recruitment and absence. As the chief executive of NHS England has rightly pointed out, the NHS has to get its own House in order. Across the health service, staff tell me they are concerned about their wellbeing and that of their colleagues. Longer hours, fewer resources, greater demands and an incredible amount of goodwill are creating a perfect storm within the NHS. The figures from the NHS staff survey show that the proportion of staff reporting work-related stress has increased from 29% in 2010 to 38% in 2014.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

In the spirit of bipartisanship touched on by my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), will the hon. Lady accept the clear evidence showing a link between good mental health and employment and comment on the number of jobs created over the past five years, which, I have no doubt, has helped to promote good mental health?

[Luciana Berger]

I am interested in the hon. Gentleman’s intervention as I am about to talk about employment and unemployment support. I am concerned by the number of constituents coming to see me about the increase in precarious employment and their ability to budget and sustain themselves from week to week.

For those who are unemployed or lose their job because of their condition, the hope of getting back into work under the Government is unjustifiably slim. The latest statistics reveal that fewer than 9% of people with mental health conditions receiving employment and support allowance have been helped back into work by the Work programme. In fact, 83% of people surveyed by the charity Mind reported that the Work programme had made their mental health condition worse. How can it be right that programmes that are supposed to help people into work are doing the opposite?

These issues alone cover the work of at least five Departments, and it does not stop there: the arts have long played an important role in helping people with mental illness; the Ministry of Justice must do much more on mental health in our prisons; and all front-line professionals, especially those in our police and emergency services, need training and support in how to respond to mental health issues.

I come now to our third and final call: we urge the Government to implement a truly cross-departmental plan to improve their response to mental health issues within our society. “No Health Without Mental Health”, published in 2011, promised to be a cross-Government outcomes strategy for people of all ages, but we are fast approaching its fifth anniversary and progress has been limited. We need a new strategy with teeth that will co-ordinate work across all Departments and set priorities, measure progress and evaluate success. We have been eagerly awaiting NHS England’s taskforce report, which was due to be released this autumn, yet we heard the other week in the Chancellor’s autumn statement that it has been delayed until next year, when the NHS England planning guidance will already have been issued. What influence or impact do the Government hope the report can have if the NHS guidance for the coming year will not take it into account?

In conclusion, mental health matters—in our schools, our workplaces and our communities. It matters to our fulfilment as individuals and to the economic success of our society. There have been important strides forward, which we welcome, but we are also concerned that too much is at risk. We hear too often that our mental health system is in crisis. We are concerned that the right help and support is not there for people when they need it; we are worried that not enough is being done to prevent people from having to turn to these services in the first place; and we are anxious that, in some areas, changes taking effect across Departments are making things worse for our nation’s mental health. Much needs to change, and we are asking for three things that will make a difference. I commend the motion to the House.

--- Later in debate ---

[Mr Hunt]

We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.

[Luciana Berger]

rose—

[Mr Hunt]

As the hon. Lady is the shadow Minister, I will give way, but for the last time.

[Luciana Berger]

I thank the Secretary of State. Will he clarify the commitment that he has just made? Does it extend to ensuring that we will be shown a clear picture of mental health spending in every area?

[Mr Hunt]

I believe that we will be able to do that, but I will write to the hon. Lady to clarify exactly what we think we are able to do. I am certainly committed to ensuring that the House is given information about the quality of provision throughout the service, and investment is a factor in determining whether the standard of that provision can be as high as we want it to be.

The hon. Lady rightly spoke of the importance of cross-Government work. We have established an innovative unit with the Department for Work and Pensions, and have set up a series of pilots to help people with mental health conditions to get back to work. We urgently need to do more to reduce the stigma perceived by employers. According to the findings of one survey, up to 40% of employers would avoid hiring someone with a mental health problem. We also want to help those who are at risk of leaving work because of mental health problems. We are working closely with the Department for Education as well. We have launched a pilot programme to create a single point of contact for schools that are concerned about pupils with mental health challenges. It now covers 22 areas and 27 CCGs.

If we are to tackle this issue, however, we need to achieve something that the Government alone—indeed, the House alone—cannot deliver. We need further progress throughout society in reducing that stigma. Bill Clinton once said:

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”

Let me end by paying tribute to the Time to Change movement, founded by Mind and Rethink, and the Dementia Friends movement, led by the Alzheimer’s Society. I also pay tribute to Members in all parts of the House who have participated in mental health campaigns, and reassure them that they have the Government’s full support as we try to change attitudes on this vital mission. Someone once said that the greatest cruelty was our casual blindness to the despair of others. Let us resolve today that when it comes to mental health, no one can ever say that about the House of Commons.

Male Suicide and International Men’s Day

Baroness Berger Excerpts

Thursday 19th November 2015 Westminster Hall

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

As the shadow Mental Health Minister, I am grateful for the opportunity to take part in this debate on International Men’s Day. I will respond specifically to the motion, which tackles male suicide.

I thank Members from throughout the House for their contributions to the debate, which have revealed just how significant a challenge male suicide is in all our communities. I also add my thanks to CALM for the work it has done to raise the profile of the issue and push for a debate on it. Its #BiggerIssues Thunderclap campaign today has reached millions of people on Twitter and across social media. That is an important indication of the strength of feeling on this issue. On Monday, the Mind media awards featured countless nominations for programmes and coverage that had raised the profile of this significant issue. The campaign award was won by the #FindMike campaign, which was run by Jonny Benjamin and Neil Laybourn, recognising the contribution that they have made to the debate.

I pay tribute to the chair of the all-party group on suicide and self-harm prevention, my hon. Friend the Member for Bridgend (Mrs Moon), for the vital contribution that she and the group have made and continue to make to the ongoing debate on suicide. As a society, we should be doing everything that we possibly can to prevent it. I also thank the Samaritans and the Royal College of Psychiatrists for their helpful briefings ahead of this debate.

The rate of male suicide in this country is a national scandal. It is shocking that in today’s society the number of people taking their own life is increasing. The fact that such a disproportionate number of those suicides are by men demands our urgent attention. I shall share again some statistics that we have already heard, because they are so significant: of the total number of suicides in the UK in 2013, 78% were male and 22% were female, and suicide is the single biggest killer of men aged under 45 in the UK. Every time a person is lost to suicide, it is a tragedy—for their loved ones, their friends, their community, and society as a whole.

Members from across the House have mentioned cases of suicide in their constituencies, and sometimes within their own families; each one is tragic and devastating in its own right. The impact of suicide can be wide-reaching and incredibly long-lasting. Apart from the obvious human cost, which often affects whole communities in schools, colleges or workplaces, we must consider the huge economic cost. I was particularly struck by the Department of Health impact assessment, which put the economic cost of just one suicide at a staggering £1.7 million.

This debate has given us an important opportunity to examine the factors that might lie behind the shocking statistics. A report by the charity Mind outlined some of the possible reasons why men are more likely to take their own life. It suggests that men compare themselves to a gold standard of masculinity, power and control, and are more likely to feel shame and guilt when they fall from that standard. There is a link between unemployment and suicide—unemployed people are two to three times more likely to take their own life. Just this week, the University of Liverpool published research into the number of suicides that, tragically, have happened in areas with a higher number of work capability assessments.

[Philip Davies]

The hon. Lady and the hon. Member for Caithness, Sutherland and Easter Ross (Dr Monaghan) try to draw attention to work capability assessments and blame suicides on them. Will she accept that it was the Labour Government who introduced work capability assessments, under which more than 60% of people were found fit for work? In work capability assessments now, only 27% of people are found fit for work, so her Government were finding more people fit for work than this Government ever have. Will she at least acknowledge that fact, rather than trying to make a rather cheap political point?

[Luciana Berger]

I pointed out just one reference to the work capability assessment that is particularly relevant because that research has been prominent in the press today. There are many other factors—that is just one—and I will come on to address them, but that research has been conducted academically and is particularly relevant this week. That is not a political point; it is something that is significant in many communities and that has been raised by Members of all parties, not just by the Opposition.

Some groups of young men are particularly at risk. Research conducted by the charity METRO found that more than a third of LGBT young people have attempted suicide at least once. Shockingly, it has recently come to light that suicides in our prisons have increased by more than 50% in recent years. Every four days a prisoner takes their own life, and the majority are men. Analysis by the Samaritans and a number of academic studies show that there is also a very strong link between socioeconomic class and suicide, with those living in deprived areas on the lowest incomes being most at risk.

Men are more likely to take risks with drugs and alcohol. They are also much less likely to open up to their friends and family and seek emotional support, as many Members have said. We have also heard concerns about the impact of economic crises on suicide rates, which I echo. My hon. Friend the Member for York Central (Rachael Maskell) referred to debt, and we also heard about the challenges in Greece, which has seen an increase in suicides.

All those individual factors are important and demand our consideration and attention, and I hope that the Minister will respond to each of them in turn. Whatever factors contribute to a person wanting to take their own life, there is one thing of which we must never lose sight: suicide is not inevitable. If people are in crisis, good care can make a vital difference, and it can and does save lives.

We have heard about the challenges in ensuring that people with mental health problems get the support that they need, and there are particular challenges due to fragmentation in the system. Service users, professionals and experts are warning of a mental health system under unsustainable pressure. The number of people becoming so ill with mental illness that they need hospital care has increased. At the same time, the number of mental health nurses has decreased, and we are hearing of too many instances of people having to travel hundreds of miles for a bed or, in some cases, not getting any help at all.

The Royal College of Psychiatrists has advised that men tend to use more lethal forms of suicide than women. It is therefore vital that the very first time someone says they have had suicidal thoughts, they get the best support possible. It is vital that that support is provided in the first 24 hours after a crisis begins. Mental health charities have long been campaigning for better crisis care. Research from the charity Mind has found that people in mental health crisis might not be able to get help immediately.

I echo the comments of my hon. Friends the Members for Bridgend and for York Central about the role of the police. Some important pilots of street triage teams are going on throughout the country. I had the opportunity to join one in Liverpool and saw at first hand the fantastic work being done by the police and mental health professionals to contend with issues of suicide and suicide prevention. They often identify people and take them to a safe place, but we know that only one third of people who use NHS crisis care services are assessed within four hours, which should concern all hon. Members. Research has found that when people present to services, perhaps after having been brought there by a member of the police or a street triage team, there are often not enough staff to provide the care that they need.

When someone has a mental health crisis and is most at risk of suicide, one of the places they are most likely to be taken is the local hospital’s accident and emergency department. I echo the point made by the hon. Member for Faversham and Mid Kent (Helen Whately): there is a serious shortage of liaison psychiatrists in acute hospitals. I have had the opportunity to join a number of such teams in A & E. They do an incredible job in very difficult circumstances and under a lot of pressure. I have heard the staff say that they are not able to deal with all the cases they would like to in an adequate time, which should concern all of us. Having experts on hand is key to ensuring that people get the support they need. I would welcome an update from the Minister on the work he is doing to increase the number and coverage of liaison psychiatrists in our hospitals.

Labour Members welcome the mental health crisis care concordat—the national agreement between local agencies to work together more closely when responding to people in mental health crisis. I note that great strides have been made in supporting the police to improve their response to people with mental health problems. However, it is not clear what tangible progress is being made on the ground in relation to suicide as a consequence of the crisis care concordat. A King’s Fund report published last week found that just 14% of people felt that they received appropriate care in a crisis. I hope the Minister will share with us his plans to evaluate what the crisis care concordat has achieved and what it might go on to achieve.

My hon. Friend the Member for Bridgend rightly raised the complex and under-researched issue of suicide contagion. I echo the concerns raised by Members from both sides of the House about the challenges caused by the lack of research into suicide. There are some great research facilities, but they are few and far between. Although their work leads the way, funding for all types of mental health research is significantly lower than funding for research into physical health conditions. Public Health England published guidance in September on how to identify and respond to suicide clusters. I hope the Minister will tell us about the work his Department is doing to understand more about and prevent suicide contagion.

Ensuring that people in mental health crisis get the support they need is an urgent priority. However, to stem the tide of male suicide, we must do much more to prevent men from reaching the crisis point in the first place. A number of hon. Members have talked about the important fact that three quarters of people who take their own life are not in contact with mental health services. Men who suffer from depression are much less likely than women to look for formal help from mental health professionals. They are also less likely than women even to talk to their family and friends about how they are feeling. We need a cultural shift so that men feel able to discuss their mental health, seek help and get the support they need.

Just as important as ensuring that men feel able to talk openly about their mental health is ensuring that when they come forward, there are services available that they feel comfortable accessing. We need to do more to ensure that men can access information about mental health problems. We must make support available in what might be considered traditionally male settings, such as where men meet, eat and watch sport. That point has already been made this afternoon. I have seen at first hand the work done by Everton in the Community, an organisation connected to Everton football club that looks at mental health in particular. It has mental health champions and does work on the football playing field and just after matches, and it has a significant impact. It is a great project and there are others, but they are not the norm, so we need to do more work.

There is a real need for joined-up working between different sectors, including health, social care, education, employment, social welfare and the Ministry of Justice, to reach out to men who are depressed and at risk of suicide. Underpinning all of that is the need for a concerted and co-ordinated approach from the Government to prevent suicide. The Government’s suicide prevention strategy was published in 2012, yet there is still a high rate of suicide in our country. The strategy has not been as successful as any of us would like. My hon. Friend the Member for Bridgend said that she is concerned that the strategy lacks teeth and that there are no timeframes or tangible reporting mechanisms by which to measure its success. Does the Minister agree that it is time for an urgent review of the suicide prevention strategy? We also need timely access to data about suicide. It is not right that there is a two-year delay in receiving such figures. What plans does the Minister have to improve the availability and transparency of information about suicide across the country?

In the light of the rising suicide rates, it is clear that we need a revolution in suicide prevention to address the fact that many more men than women take their own lives. For too long, mental illness has been the subject of stigma and prejudice, which means that people—particularly men—often feel that they cannot talk openly about their mental health problems. A few brave public figures, such as Stephen Fry, Graham Norton and my hon. Friend the Member for North Durham (Mr Jones), have spoken up about their own mental illness, but for too many people mental health remains hard to speak about openly. Only last week, in my constituency surgery a man in his 50s told me that he is not able to relate to either his siblings or his parents about the mental health condition he has been affected by throughout his adult life.

It is incumbent on all of us to make the rhetoric about parity of esteem a reality. Challenging stigma is key to making equality for mental health a reality. We need a cultural shift in our schools, colleges, universities and workplaces to enable men to discuss their mental health and feel able to seek help. We need to overcome the stereotypes of masculinity placed on men’s shoulders and give them the support they need. Each suicide is a terrible tragedy and a waste of precious life. Members from both sides of the House have talked about the important work that must be done to tackle the challenge and about the many practical steps that must be taken. It is clear from their contributions that together we can prevent suicide and save the lives of many men. I look forward to the Minister’s response.

--- Later in debate ---

[Alistair Burt]

My hon. Friend is absolutely right. Those connected with housing increasingly recognise the relationship between housing, mental health issues and suicide. When I was with my hon. Friend the Member for Derby North, I met the lady responsible for the YMCA there and its housing outreach, and she made some pertinent comments. Housing and homelessness are closely connected with the problem we are discussing, and I commend the constituent that my hon. Friend the Member for Worcester mentioned.

We know that men are often reluctant to talk about mental health problems. Many colleagues have referred to men’s attitudes, so I do not think that I need to labour that point. They are reluctant to seek help when they need it. In part, we know that is because some men feel that it may be a form of weakness. We need to assure men that that is not the case, as many colleagues have said. We, along with the charities Mind and Rethink Mental Illness, are seeking to reduce the stigma around mental illness through the Time to Change campaign.

Time to Change aims to empower people to challenge stigma and speak openly about their own mental health experiences—particularly men—and to change public attitudes towards those with mental health problems. The campaign has improved the attitudes of more than 2 million people. However, we know that men can be a particularly hard-to-reach group, and we are looking at further ways to improve reach in that area.

We know, tragically, what the outcome of unacknowledged mental ill health can be for a person. When someone bottles it up—that phrase was used in this Chamber today—their condition can worsen and may, in the worst cases, increase the risk of suicide. As I mentioned earlier, suicide rates in England remain low compared with in other European countries and other UK administrations, but I am concerned, as we all are, to see that rates have been rising in recent years. We anticipated that after the global financial crisis in 2008, and it has been seen in other countries around the world, as the hon. Member for York Central said. We know about that, but it is important that the inevitability of that does not go unchallenged. We can appreciate that such times bring extra pressures, but we need to ask what we can do when we know they are coming.

We know that the recent rise in suicide rates has been driven by an increase in male suicides, which is what led my hon. Friend the Member for Shipley to call for the debate in the first place. The threefold difference between male and female suicide rates has increased further, and we know that is a common experience in other countries around the world. It is right, therefore, that preventing suicide is dominated by efforts to prevent male suicide, but we recognise that this issue affects everyone. Whether men or women, boys or girls, when it happens it is an immense tragedy.

The greater risk of suicide among men is a complex issue. Many of the clinical and social risk factors for suicide are more common in men. Cultural expectations that men will be decisive and strong can make them more vulnerable to psychological factors associated with suicide, such as impulsiveness and humiliation. It is critical that, in addressing those issues, we provide information and support in a way that suits men’s needs and behaviours, and that we provide services that are appropriate for men, which may include moving away from traditional health settings.

What are we doing about it, and what will we do about it? We published the cross-Government suicide prevention strategy for England in 2012, and I am committed to implementing it by working across Government and with our partner organisations in the NHS and other sectors such as transport and the community, voluntary and charitable sectors. I will also be speaking to our partner organisations soon to discuss how we can review and strengthen the national suicide strategy. I want to make it clear that I see that as a dynamic and flexible instrument, not as something that we will do and then I will see how it works and make some decisions in years to come. We are looking at it now. It needs to be reviewed and refreshed now. It is an ongoing process, and I am committed to it.

The objectives of the strategy are to reduce suicide and to support the people bereaved or affected by it. It is right that men are identified in the strategy as a high-risk group for whom our suicide prevention activities should be and are prioritised. The strategy also recognises that schools, social care and the youth justice system have an important contribution to make in suicide prevention by promoting mental wellbeing and identifying underlying issues such as bullying, poor self-image and lack of self-esteem.

As well as having the strategy, we continue to provide financial support for the National Suicide Prevention Alliance, which brings together our key partners across Government and the community, voluntary and charitable sectors with expertise in suicide prevention. I am particularly pleased to say that many of the organisations that campaigned for the debate are members of the NSPA. It has been working with all those organisations to develop its strategy for delivering improvements in suicide prevention, which I welcome. My Department of Health officials are helping with that work. Those organisations make tremendous individual contributions to suicide prevention. The Campaign Against Living Miserably, which was prominent in calling for this debate, works tirelessly to target men specifically, and to support them, so that they feel able to talk about mental health issues. The Department of Health provided financial support to CALM in its early days, and I am proud to see how it has grown in size and profile.

I have had a variety of meetings on the issue since I took office; I have mentioned some already. I went to see the Samaritans bereavement centre in Peckham for World Suicide Prevention Day, and to mark the launch of a new initiative between Cruse Bereavement Care and the Samaritans. I met the British Transport police and saw the extraordinary work they do with Network Rail. I saw some of the triage work going on in Birmingham, including placing a mental health professional in the police control room 24 hours a day to help provide necessary information. I held a meeting on suicide prevention on 29 June, with researchers, the Samaritans, and representatives from areas such as Merseyside, the east of England and the south-west.

We have started to look at something called zero suicide. I have an interest in the concept and ambition of zero suicide. It was pioneered in Detroit by a college acquaintance of mine from many years ago, Ed Coffey, and I am very interested in his work. We can follow part of it, although some things are different in the States and will not be pertinent here. The whole concept of zero suicide—recognising that as an ambition, and challenging the inevitability of suicide—is really important and has very much grabbed my attention. Public Health England also recently published the refreshed “Help is at Hand” document, which provides compassionate support and information to people bereaved by suicide.

I will conclude by saying a little about research and data, as it will cover a number of issues raised by colleagues. One of the key drivers for improving our approach to suicide prevention is investing in research and data. I want us to lead the world in suicide prevention research, and to be at the forefront of service delivery, using the best knowledge and information to provide the best care. We have invested over £1.5 million in suicide and self-harm prevention research since bringing in the national suicide prevention strategy, to inform and target our strategy for reducing suicide rates. I will have a look at whether that is enough, and at what more needs to be done.

The hon. Member for Bridgend mentioned longitudinal studies. We are committed to carrying on the work on that. We have provided the Multicentre Study of Self-harm in England with £300,000 this year. I will very much bear in mind the opportunities that there might be for us to do more.

The zero suicide ambition I mentioned is being piloted in three areas: Merseyside, the south-west and the east of England. Early learning from the pilots has identified some innovative practice, which I am sure will help other areas to develop innovative plans for reducing suicide in their communities. There will be more research that we can work through to find whether it could have applications elsewhere.

[Luciana Berger]

Will that work extend to our prisons, which are a particular area of concern?

[Alistair Burt]

I know the Ministry of Justice is looking closely at the increase in prison and detention suicides. Again, it is not huge, statistically, but any increase is a matter for concern.

The work capability assessment has been mentioned. It started in 2008, which is about the time that the rise in suicides began. The authors of the recent study that has been mentioned have said that they were cautious about making a link or claiming cause and effect, but I have already asked the Department of Health to have a look at that study, because I feel it is important that my Department looks at the matters involved.

This has been a really good and important debate. First, it has put the issues connected to International Men’s Day on the agenda and allowed us to talk about male issues, in a way that is not a zero-sum game. We have been able to make reference to some difficult issues that are not discussed enough, and I am grateful to my hon. Friend the Member for Shipley for that. We have spent the bulk of our time discussing suicide, and Members on both sides of the House have been able to work together and demonstrate a common interest in things that affect us all. The sense I get from everyone is that none of us is prepared to accept the status quo and simply see the statistics accepted—my hon. Friend the Member for Bury North made that point.

These will not be easy issues to tackle. More men commit suicide than women, not because someone is making them do so—it is not anyone’s fault—but that is a fact. What more can we do? What can we learn from overseas and from the work being done in different areas of this country? I am absolutely confident that this House will talk about this issue again. I hope that when we do, we will have learned still more. People and organisations outside the House do such excellent work on this; with the benefit of that work, perhaps our ambition to make this the country with the best suicide prevention strategy in the world can, in time, become a reality.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

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

Last week, yet another report—this one from the King’s Fund—warned of a mental health system that is under huge pressure. On this Government’s watch, just 14% of patients feel that they have received appropriate care in a crisis. The number of mental health nurses has dropped, and increasing numbers of people are having to travel hundreds of miles for a bed. What action will the Minister take to turn his rhetoric into reality?

[Alistair Burt]

This is a cross-party matter and it is very important. We believe we have made strides during both the previous and this Government. We are investing more money in mental health services—it was increased to £11.7 billion last year—and this was the first Government to introduce standards for access and waiting times with regard to mental health, to try to put it on a par with other conditions. That was not how it was done before. We will now try to ensure that the money that goes in nationally is used to provide assistance locally, and that the money that is put in for local use is used locally.

There are areas to celebrate. We are world leaders with the improving access to psychological therapies service, which has treated 3 million people since 2009. We want to build on that. We know that the service has lagged behind others in the past, which is why we are determined to do much more about it. I think it is the view of the whole House that we should do more about it, and we will.

[Luciana Berger]

I listened very carefully to the Minister’s response, but I reinforce the point that the suicide rate in this country is going up, not down. It is a national scandal that we need to address.

The Minister mentioned prevention. The Government have confirmed that they will make an in-year £200 million cut to local public health grants. That is a political decision. It is not going to save money and, apart from the devastating human price, it is going to cost our NHS and our local authorities more as they deal with both physical and mental ill health that could have been prevented. How can the Minister justify that?

[Alistair Burt]

First, £1.25 billion is going into creating new services for children and young people’s mental health services during the course of this Parliament. The hon. Lady’s party did not make that commitment before the general election. More work is being done in schools to provide a better base for mental health. We have, for the first time, appointed in the Department for Education a Minister with responsibility for mental health in schools.

The pressures on public health budgets are the same as those on every other budget. Those pressures on the national health service were met by my colleagues during the general election, with a commitment to provide an extra £8 billion—the figure is now £10 billion—by the end of this Parliament. That commitment was not made by the hon. Lady or her party. She asks for more money to be spent, but we have committed to do that and we are finding it. It is very important that we take the position that we have to do as much as we can with what we have got. Mental health services are moving forward and we should take the opportunity to say that and welcome what has been done. We have provided the resources in a way that I am afraid the hon. Lady’s party did not.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 13th October 2015 Commons Chamber

[Alistair Burt]

I believe we are. I will check to be certain, as I know the right hon. Gentleman knows a great deal about this, but I believe we are. We have £150 million for eating disorders, and £30 million is being spent this year, with additional beds allocated. I will check that the waiting target times remain because they have made a significant difference. The right hon. Gentleman’s work has been of powerful import in what we do.

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

Yesterday, the National Society for the Prevention of Cruelty to Children revealed that one in five children in need of mental health treatment are being turned away. Is it not appalling that young people are being denied help, only for them to become more seriously ill later on, and that the number of children turning up at A&E because of mental illness has doubled in recent years? Does the Minister accept that children’s mental health needs more money now—this year, as he promised? I can point to many different organisations across the country that would gladly receive that support now. How is he going to put his broken promise right?

[Alistair Burt]

May I welcome the hon. Lady to her position, not least her Cabinet position—he said carefully—and welcome the prominence that mental health now has among all parties? Let me say rather gently in response to the tirade that I have just received that under this Government we have for the first time introduced parity of esteem for mental health on waiting times and national access targets. We are spending more money—£1.25 billion over the next five years. We have the highest number of beds for young people in emergency situations; we have the first dedicated education Minister for young people’s health; we have £75 million for perinatal health; and in her own constituency, the hon. Lady will be pleased to welcome from her shadow Cabinet position an extra £1.1 million going to Liverpool for mental health treatment for children and young people. I think that is a significant response.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 7th July 2015 Commons Chamber

[Alistair Burt]

Yes, and the adaptation of new and innovative therapies will also assist. Ensuring that GPs are aware of the increased access to psychological talking therapies is making a huge difference. Initial reactions to that programme indicate that, since 2008, nearly 3 million people have had access, 1.7 million have completed their treatment, and 1 million have recovered. Increased awareness of that in primary care will be very important.

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

Last month’s Care Quality Commission report revealed serious shortcomings in emergency mental health care, including that too many people do not have access to urgent help around the clock. The lead mental health inspector said that those findings must act as a wake-up call. How is the Minister ensuring that people in a mental health emergency get the same support that we would expect them to get in a physical health emergency?

[Alistair Burt]

The extremely important report to which the hon. Lady refers was commissioned by the Government. It described the crisis care concordat, which is at the heart of dealing with mental health crises, as a “remarkable initiative”. It states:

“An extraordinary range of public services and other bodies have acknowledged their responsibilities”.

For me, it serves as a baseline for what we should do. The word “efficiency” is pointed out, not least in respect of A&E treatment of those with mental health crises. I regard it as a very good base on which to work and to gauge the success of what we do to deal with mental health crisis care over the next few years. I commend the crisis care concordat—it is in operation all over the country—as a first step towards ensuring that the sort of treatment we want in mental health crises becomes the norm.

Drugs: Ultra-rare Diseases

Baroness Berger Excerpts

Tuesday 16th June 2015 Westminster Hall

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

It is, as ever, a pleasure to speak under your chairmanship, Mr Crausby. I, too, commend the hon. Member for Leeds North West (Greg Mulholland) on securing this important debate on access to medicines for ultra-rare diseases and on his contribution to this debate. He has pursued the issue doggedly through debates and questions, and it is right that he has been allotted time to bring these matters to the attention of the Government today.

I commend the UK parliamentary outreach team for hosting the online debate on this issue yesterday on Twitter, using #RDdebate. The public have had an opportunity to contribute to and inform this debate, and that is valuable. I am aware that many are watching us this afternoon. I also welcome the Minister.

When viewed collectively, it is more than apparent that rare diseases are simply not that rare. One in 17 people will be affected by a rare disease at some point in their life, which means that some 3.5 million people in the UK have a rare disease. About 75% of rare diseases affect children and almost one in three rare disease patients will die before their fifth birthday. These are sobering statistics and it is clear that more must be done.

In June 2009, the previous Labour Government adopted the Council of the European Union’s recommendation on action in the field of rare diseases, which recommended that member states should establish and implement plans or strategies for rare diseases. Following the work set out under the Labour Government, the coalition published the UK strategy in November 2013, and NHS England published its statement of intent with regard to the UK strategy in February last year. Since then, we have had the five-year forward view, which reaffirms NHS England’s commitment to achieving better outcomes for people with rare diseases. While each of the publications is a step in the right direction, so much more needs to be done, as many have said this afternoon. The health reforms of the Health and Social Care Act 2012, which was introduced by the coalition, have seen patients and professionals left to navigate a labyrinth to access particular medicines that in many cases have already been approved and received licences.

We have heard already about tuberous sclerosis complex. It is a rare genetic condition that is estimated to affect 1 million people worldwide. Those with the condition develop non-cancerous tumours, often in the brain, eyes, heart, kidney, skin and lungs. Often, TSC patients are at risk of complications, and surgical removal of the tumours is not always an option. It can have a massive and often severe impact on a person’s quality of life. We have heard about a drug called Everolimus that has been developed to treat some tumours associated with TSC; it has been granted market authorisation by the European Medicines Agency. However, despite being licensed in the UK 28 months ago, it has not been appraised by NICE. It is only available through the NHS on an individual basis or through the cancer drugs fund, resulting in significant inequalities in patient access.

Another example we have heard about throughout this debate, and on other occasions in recent weeks in the House, is Duchenne muscular dystrophy, which leaves many patients wheelchair-dependent by the age of 12. The drug Translarna received conditional approval in the EU in August 2014 for the treatment of DMD. However, almost a year on, too many boys who could benefit are still awaiting a decision on funding from NHS England. I commend my hon. Friend the Member for North Tyneside (Mary Glindon), who has done so much to raise awareness of the issue on behalf of her constituents. As we have heard, many Members from all parts of the House also have constituents who are affected, and the hon. Member for Romsey and Southampton North (Caroline Nokes) made a passionate contribution. Each day of delay sees the boys come closer to losing the ability to walk, by which point they would no longer be eligible for the drug.

Countries across Europe have already approved the drug. The UK has taken a leading role in clinical trials for Translarna, but we are lagging behind other European countries in the delivery of the drug to patients. Will the Minister tell us why we have fallen so far behind? I understand that NHS England is set to take a decision on funding shortly. We often hear the word “shortly”, so will he provide a further update and clarify and qualify what “shortly” actually means?

The system to approve prescription is confusing and frankly chaotic. There are seven pathways through which drugs for rare diseases can be evaluated and made available to patients. I will not go through every one of them, but it is clear that there is no clarity in the process to decide on which pathway a particular drug will be put. In particular, owing to a lack of clarity and transparency in the process, information on how or why one medicine evaluation approach or access route is selected over another is simply not available. Will the Minister outline the steps the Government will take to clarify the process, to speed up decisions and to make those decisions more open, so that patients can better understand the process?

I have specific questions for the Minister on two of the pathways: the highly specialised technology evaluation programme, which is administered by NICE, and Evaluation through Commissioning, which is administered by NHS England. There is significant concern that they could limit access to medicines for people with rare diseases. There are widely held concerns that the process in the highly specialised technology evaluation programme, introduced following the 2012 Act to appraise medicines for rare diseases, is too opaque and that the topic selection process is out of date. Does he have any plans to work with NICE to update the selection criteria for the pathway, as they do not take into account conditions defined by genetics, biomarkers or differences in clinical presentations?

Do the Government have any plans to increase the resources available to NICE to evaluate drugs through the highly specialised technology evaluation programme route, given that it is only resourced for three drugs appraisals a year, despite the European Medicines Agency licensing more than four times that amount? Finally, it is essential that patient groups have input on the process by which the drugs upon which patients rely are appraised, but a consultation on the programme has not yet been announced. When does the Minister expect that to take place?

Evaluation through Commissioning is a specialised commissioning pathway to conduct pilots to collect data to inform the decision-making process on funding for specialised commissioning proposals. It is more than a year since Commissioning through Evaluation was expanded, and a few months since it was rebranded as Evaluation through Commissioning. Will the Minister update members on the progress the process has made in expanding patient access to drugs? As I understand it, no medicine has been selected for the programme. When does he expect that to change? Will he update the House on the effectiveness of the early access to medicines scheme to date?

There are more than 6,000 rare conditions. A disease can be described as rare, but having a rare disease is clearly anything but. Improving access to medicines and treatments for the 3.5 million people affected by rare diseases is crucial in improving their quality of life. We have heard moving personal stories from Members from all parts of the House in this debate. I was looking on Twitter at some of the contributions made by members of the public in the past 24 hours. One tweeter said:

“If I could go on the #vimizim I could start to work and pay taxes for others to get hold of the drugs they need”.

That is just one contribution among many, and I ask the Minister to reflect on them after the debate. Many issues need addressing to improve the system of medicine appraisals, and we have touched on just a few today. I hope the Minister will take on board what Members have said, and I look forward to his reply.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

The right hon. Gentleman is quite right. Tackling obesity is one the great public health challenges of our age. Right across the developed world we are looking at all the things that are going on around the world—the new science and the new research. The right hon. Gentleman is right to say that industry has a role to play, as has every part of Government—national Government and local government—as well as families, GPs and the NHS. This will be a whole-nation approach to tackling obesity. We are working on our plans, which I look forward to discussing with him in due course.

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

Type 2 diabetes is costing our NHS £9 billion a year, and obesity, as we have heard, is the major risk factor. Does the Minister agree with the previous Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), who said the other week that

“Just taking a passive approach to”—

obesity—

“is not going to work…we have to go further than we’ve gone up to now in the responsibility deal”?

Does the Minister agree and what more is she going to do about it?

[Jane Ellison]

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.