NHS Pay

Lyn Brown Excerpts

Wednesday 24th March 2021 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab) [V]]

It is a real pleasure to see you in the Chair, Mr Hosie—and looking so well. I thank my hon. Friends the Members for Liverpool, Wavertree (Paula Barker), for Luton South (Rachel Hopkins) and for Birkenhead (Mick Whitley) for securing this debate.

For the last year, as has been said, our NHS staff have been toiling night and day, working bravely and selflessly to protect us from this terrible virus. Even before this pandemic, NHS staff were working an extra 1.1 million hours of unpaid overtime—it is a disgrace. It is those same nurses, doctors, porters, ambulance drivers, paramedics and so many more who have kept our wonderful NHS going. Even when they were on the brink of being overwhelmed by the fifth highest covid death rate in the world, and despite the terrible trauma they have experienced, our doctors and nurses have held people’s hands as they died alone. They have watched the fear and borne the grief of 126,000 people and families, and counting.

Now our NHS staff are on the brink of being overwhelmed too—they are simply exhausted. They have done their jobs bravely night after night, day after day, and they are still doing their jobs, with barely a break, a full year on. My gratitude is beyond words. But we must recognise that NHS staff bear scars from the past year that will last. Almost 60% of nurses experienced a mental health problem during that first wave. In some trusts, the proportion of staff absences relating to mental ill health has doubled.

Our NHS bears the scars too. In January, more than 300,000 people waited more than a year for treatment in hospital, and that figure will have only grown. Our NHS will recover its full health and wellbeing when its staff can recover theirs. That requires action to guarantee decent pay, conditions and, basically, respect. After all our NHS has gone through, if we offer real-terms pay cuts, rather than what our NHS heroes deserve, our gratitude will prove hollow, superficial and meaningless, and it will damage our NHS further. How disgraceful is that? How much more will the health of communities suffer?

The people who have cared for us deserve so much more. This Government must understand the needs of the NHS, deliver for its staff and deliver now.

Covid-19 Vaccine: Take-up Rates in London

Lyn Brown Excerpts

Tuesday 9th March 2021 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab) [V]]

The truth is that the vaccine roll-out has not worked as well as it might for the vulnerable of London. In West Ham, it has been about age. We are one of the youngest areas in Europe and we have had the highest excess deaths. The numbers in the highest-priority groups, especially the over-70s and 80s, are low; consequently, our areas were allocated vaccine supplies at a level far below what could have been delivered. We have had disproportionately large numbers with clinical vulnerabilities—illness linked to higher levels of deprivation—but they were in the top four priority groups, so clinicians have only just started to vaccinate them.

Sky News found that Newham had the highest excess deaths in the UK between March and mid-January. Some 15 of the top 20 areas for excess deaths are in London. Local clinicians have constantly called for the flexibility to vaccinate younger people with clinical vulnerabilities, and I know that Ministers will remember that I have echoed those calls. However, I am not here just to complain, because I am very grateful that Ministers and officials have listened, and I am hopeful that London CCGs will be given greater flexibility to deliver second jabs. More than anything, we have to focus on the role of deprivation, because it is the major barrier to speedy vaccinations.

GP data is limited in areas such as mine because people move, from one short private rental to another, over and again, and so many are in temporary accommodation. Those in poverty and insecure work are less likely to be able to keep their phone contracts and hang on to the same number, which makes it hard when so many vaccine appointments are organised by text. People do not have access to broadband or mobile data, and the consequences are clear.

For the affluent group in DQ5, uptake has been 60%. For the most deprived group, DQ1, it has been just 37%, and it drops at each step, from DQ5 to DQ1. We must find better ways to address this, because we are letting down the vulnerable and it is hindering our collective ability to fight this virus. I would therefore like to hear more from the Minister today about how we will tackle this.

But I do not want to finish without heaping massive praise on our NHS locally—our fantastic local GPs, our local public health teams and all our volunteers. I genuinely cannot thank them enough. They are working together with such tenacity and extraordinary commitment, and I thank them from the bottom of my heart.

Covid-19

Lyn Brown Excerpts

Tuesday 12th January 2021 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab) [V]]

This crisis has created unbearable pressure on our nurses, doctors and hospital leaders, and I want to thank them for all they do. Many NHS staff are effectively the walking wounded. They have been operational without a break, exhausted, stressed and traumatised, for so long. Today, I want assurances that when decisions are made about how and when to end this lockdown, Ministers will be guided only by science, resources and the trajectory of the virus.

When staff are so stretched, local decision making about resources is paramount. Last week, we learned that the Nightingale in Newham is to be open for patients as well as for vaccination, but there is suspicion in my patch that some decisions are not based on clinical need, because there have never been enough staff to run the Nightingale at a reasonable capacity. We are struggling to staff the facilities that we have got. Where are all these additional medics coming from? We need sensible local decisions. For heaven’s sake, we have the highest infection rate in London.

I know that we have absolutely no choice but to lock down hard to save lives, but that has to be matched with fair support for all. I am thinking especially about the hospitality, events and cultural sector, which is struggling. The wedding industry is huge in Newham. It has had to push back the time when it can take bookings again, and it is struggling. So is the supply chain and its employees, and wedding dress shops, caterers and jewellers too.

We pray that the vaccine programme works, and that it works rapidly, but vulnerable sectors in our economy will need support for months. Yesterday, however, the Chancellor offered no additional support—nothing new to protect struggling sectors of the economy, nothing for struggling families, and still absolutely nothing for those excluded from support time and again. Why did he bother to turn up?

Why are we seeing children living in poverty still with no IT devices or broadband, and why are they now being cheated out of food that the public purse paid for? Surely, every single Member has seen the paltry rations we are told 30 quid pays for. Seriously, where are they shopping? We knew for months that this moment was coming again. This ain’t our first lockdown—we knew what the implications would be. There are absolutely no excuses for constantly doing too little, too late.

Covid-19

Lyn Brown Excerpts

Thursday 22nd October 2020 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

In West Ham, we had the highest number of people furloughed in the country—almost 30,000. All of those people and so many more who are self-employed are potentially at risk of real economic hardship, and we simply do not know how many more will lose their work over the coming winter. The scope for damage to our already deprived and very vulnerable communities in Newham is vast.

As we know, there are differences in economies across the country. In my constituency, many parents work two or three jobs to pay their rent and their living costs. Let me tell Members quickly what it is like in Newham. The lowest quartile of private rent is higher than the lowest quartile of earnings. A month’s wages does not even cover the rent on its own. In many cases, if parents lose one source of income they will be under threat of homelessness and it will immediately mean cutting back on the things that children need and that parents want to provide, such as food, clothes, shoes for the winter, internet access and books. In this wealthy country of ours, losing that second or third job will leave parents with no choice but to cut back on food—first for themselves and then for their children. We know that when parents are pushed into poverty, the impacts can be lifelong on their children’s health, education and opportunity.

Last week, the End Child Poverty coalition estimated that almost 20,000 children were in poverty in West Ham alone—20,000 children! That is more than half the children in our local schools, and those numbers are from before the pandemic began. We have 20,000 children living in poverty in just one constituency. I worry about how bad this is going to get even if the Chancellor does not follow through with his threat to cut universal credit next year, and I hope to God he does not.

Around 575 school days have been lost since March. Only 8% of children with special educational needs and disabilities or under the protection of a social worker attended school during lockdown—8%! How can schools or local authorities identify the children who are at risk of abuse or neglect when they are not being seen? Self-isolation for covid is a really quick excuse that can be used for everything. Our services need to find new ways to proactively check children at risk and they need the resources to enable them to do that.

In my area, county lines see gangs grooming children with life-destroying consequences. This problem is now even more acute, because normally extended absences from schools are one of the clear signs that a child is being exploited to run drugs and put at risk of seeing and doing things that no young person should see or do. If preventative support is not given, it will create more damage in our communities and more costs for the public purse in the future, but most of all it will kill the hopes and the dreams of the children and the parents in deprived communities, cause much pain and waste so, so much potential.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lyn Brown Excerpts

2nd reading & 2nd reading: House of Commons
Friday 16th October 2020 Commons Chamber

[Anthony Mangnall]

I hope that my hon. Friend will take it as a compliment when I say that she is ageing beautifully.

[Ms Lyn Brown (West Ham) (Lab)]

I have sat through this debate and been a little discomforted by some of the remarks that have been made. I say that very gently. I support the hon. Member for Stourbridge (Suzanne Webb) in her gallant attempts to get an understanding in this Chamber that young women and young men are beautiful in who they are and not in what they have done to them. That is the message that we should be sending out. I know that I have aged wonderfully, so I do not need the hon. Gentleman to tell me so. May I just emphasise the hon. Lady’s words, as I completely and utterly agree with the position that she has been enunciating over the past 20 minutes?

[Anthony Mangnall]

I thank the hon. Lady for making that very important point, and I take her guidance incredibly sincerely. That brings me to the point made by my hon. Friends the Members for East Surrey and for Hastings and Rye (Sally-Ann Hart), which is that every child is beautiful and that body positivity as we grow up is incredibly important. We are not asking anybody to change their image. I thank the hon. Lady for her point; I am always happy to take guidance on how to perform in the Chamber.

The impact of social media is long lasting, and our newspapers and media have become more and more emboldened about it.

NHS Hysteroscopy Treatment

Lyn Brown Excerpts

Thursday 24th September 2020 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

I am really grateful to you, Madam Deputy Speaker, and it is really good to see you.

This is the eighth time I have raised in this House the way women are treated by the NHS when they need a hysteroscopy. I have always had a sympathetic hearing. Throughout the years, I have given voice to an ever-growing group of courageous women, the Campaign Against Painful Hysteroscopy. I am sad to tell the House that the issue has not been resolved. Far from it. Women are still being denied the right to provide informed consent and having their pain ignored while a procedure is performed, and some suffer lasting trauma as a result of a hysteroscopy.

For those who do not know, a hysteroscopy involves a camera probe being inserted into the womb, past the cervix. Sometimes, a sample will be cut away from the woman’s womb for examination—it will be cut away from her womb. A hysteroscopy can be an important tool for diagnosing the causes of common problems, such as unusually heavy periods, unexplained pain or bleeding. It can enable life-saving treatment to begin, or provide invaluable reassurance that a problem being experienced is not caused by cancer.

It is true that for some women, sometimes, a hysteroscopy causes only minor discomfort, but for others it causes agony and a sense of violation, because hysteroscopies are often carried out in NHS hospitals with little or no anaesthetic. Frequently, women are simply advised to take paracetamol or ibuprofen for the pain.

[Jim Shannon (Strangford) (DUP)]

First, may I say how nice it is to see the hon. Lady back in the Chamber? I am very pleased to see her.

Someone very close to me is going through this particular thing at the moment, so I understand exactly what the hon. Lady refers to. Does she agree that some women’s experience of this treatment is truly extreme, and that pain medication must be made available for those who need it, as opposed to stopping and sometimes redoing the procedure?

[Ms Brown]

The hon. Gentleman is absolutely right. It is a delight to see him in his place, too. I will come to the lack of pain relief for women and just how damaging that can be for them, not only in that moment but often for their ongoing healthcare, because it creates fear and a barrier.

Massively improved information leaflets have been produced by the Royal College of Obstetricians and Gynaecologists, in collaboration with patients. I am also pleased to note that the NHS website, which I quoted from in the last debate, has now been changed to recognise that some women experience severe pain and a general anaesthetic should be an option. However, many women having a hysteroscopy are still not being given this essential information. They still are not having the risk of severe pain discussed with them properly, and they still are not having the option of a more effective anaesthetic offered freely. In truth, these women cannot give genuinely informed consent, and therefore their rights as patients are being violated.

Telling the story of your trauma is very difficult. The excellent women at the Campaign Against Painful Hysteroscopy are still a relatively small group. Despite that, the campaign has collected 1,500 personal accounts of painful hysteroscopy. Previously in this House, I have told the stories of women who have been held down as they tried to stop the procedure, who have collapsed from shock, bleeding in hospital car parks afterwards, and who have been criticised by doctors for their supposedly low pain thresholds because apparently “most women are fine with it”. Today I will raise the voices of three very recent hysteroscopy patients, because I want the Minister to know that this barbarism is still taking place.

Rebecca had a hysteroscopy last year. She was given no information before her appointment, received no warnings about severe pain and was not offered sedation. Fortunately, Rebecca had had a similar painful procedure before, so she asked for pain relief and was offered a local anaesthetic injected into her cervix. That, in itself, was painful, but she hoped beyond hope that it would be worth it, and the doctor reassured her that the procedure had been massively improved. Instead, Rebecca said:

“As the probe was inserted I struggled to believe how severe that pain was. As the biopsies were taken… I could feel my insides being cut away and I had absolutely NOTHING to address the agony of it all! I was trying not to scream, very close to vomiting and fainting. In trying to contain my screams I couldn’t speak—if I had, the screams would have ‘escaped’ and I knew that they would be deafening. The procedure seemed to go on and on. It was barbaric and, as I hadn’t been given any warning, I felt panicked and unsafe.”

After they were “finished” with her, in her words, she says that no one cared that she felt faint, was close to tears and was struggling to walk. Rebecca tells me she felt conned, and not treated as a human being but

“an object to cut bits out of”.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

I am grateful to my hon. Friend for highlighting what many women have been suffering in silence. The Minister’s reaction to this is profound. Does my hon. Friend agree that the Government must ensure that the national health service provides proper guidance and instruction to practitioners, so that women do not suffer in the way her constituent did?

[Ms Brown]

The reason I am here tonight is to continue the campaign, because it has been going on for some years. I first spoke about this in an Adjournment debate, and an hon. Gentleman I know who sat on the Front Bench took it back to the Department of Health. This campaign has gone on for quite a long time.

Let me tell the House about Vidya. Vidya had a terrible experience with hysteroscopy earlier this year. Vidya has had a vaginal birth. She has experienced that pain, but when the camera was inserted into her womb, Vidya felt such agony that she was not even able to tell the doctor to stop. Like Rebecca, she simply could not scream out. Vidya had not been asked to sign an informed consent form. She was not asked about the level of pain she was experiencing at any time. She said:

“I can’t eat, I can’t go out, I cannot stop reliving the agony in my mind. If I sleep I wake up with terrifying nightmares. I can’t stop crying.”

Like so many of the women who have had to go through this, Vidya has lost trust in healthcare professionals and in our NHS, and I think she is likely to have post-traumatic stress disorder.

I would also like to talk about Alison. She was completely unaware that she was going to have a hysteroscopy until she arrived at the hospital. She had not been sent a leaflet or told anything to prepare her. She had not even had a paracetamol. She said:

“The pain was like I had been thrown into full-on labour contractions. I was crying and screaming out…panting…my heart was racing. The pain was off the scale. After I left the hospital crying in my sister’s arms, she had to help me to the car. I cried solid for 14 hours. This will stay with me the rest of my life.”

Alison’s hysteroscopy took place last Wednesday. These violations of patient dignity and rights are still happening regularly, seven years on. They have to be stopped. I would be happy to send the survey to the Minister, as I have done with previous Ministers, and I hope she will find the time to read through the accounts herself.

Personal experiences are the most important thing here, but there is also new scientific evidence. On 14 September this year, the British Journal of Anaesthesia published an analysis of eight years of data on hysteroscopy outpatients. It found that 18% of patients reported pain at a level of seven or more out of 10, and only 8% reported no pain. Almost 40% of patients were given no pain relief and only 2% were given a local anaesthetic. The doctors and their patients reported back. The clinicians’ judgments about pain seemed to be the very opposite of what their patients actually felt. The doctors who had given an anaesthetic, even a low dose, reported observing very little pain. Sadly, they were not seeing the reality of their patients’ experience. Their patients reported feeling pain when the doctors said there was none. The study suggests that the doctors are, frankly, terrible at judging the extent of the pain of the women in front of them. It also suggests that local anaesthetics are not enough for many women.

We know that our NHS is overwhelmed by covid. We all understand the pressure that the NHS and the Department of Health and Social Care are under. I also understand the pressure that Ministers must be under, but I hope that the Minister will commit, like the last Minister, to taking forward this issue quickly to ensure that the necessary change happens. In January, I asked if pain during hysteroscopy could be included on the agenda of the women’s health taskforce of England. I was told that the taskforce would be open to it, but then came covid. So can the Minister tell me whether the taskforce has met since January? Has it discussed the issue of suffering during hysteroscopy? If not, will she commit to including it when the taskforce next meets?

Also in January, I followed up the most fundamental changes that I think we need to see. The NHS is currently actively encouraging hospitals to perform hysteroscopies as outpatient procedures, with no possibility of a general anaesthetic or other sedation, through the ironically named NHS best practice tariff. Due to the tariff, an NHS manager’s trust will lose money if it provides a general anaesthetic. I have raised the problem of the best practice tariff several times now. Last year, I sent submissions to the utterly opaque and unaccountable consultation conducted by NHS Improvement—also ironic. Like many women of the campaign, I did not even receive a proper response. That is simply a disgrace. Women must not be ignored. We must see the change we seek.

In my last debate in December 2018, I had four straightforward asks. Sadly, they are still relevant today. I want to see: better information to enable informed consent; improved training, especially on the risk factors and forms of pain relief that doctors are trained to offer; every trust properly funded for the most effective and necessary forms of anaesthetic appropriate to hysteroscopy patients; and, finally, permanent removal of the perverse financial incentive that puts more women at risk of trauma. I hope the Minister will tell us about what action the Government might take on each of those.

Every time I have raised the experiences of the many women who have suffered as a result of hysteroscopy, I have had a genuinely sympathetic response. I genuinely believed that the former Minister, the hon. Member for Thurrock (Jackie Doyle-Price), was taking forward our case within Government, but the work she started did not seem to be allowed to come to fruition. I have to ask why.

If women’s health, informed consent and patient safety are genuine priorities for the Government, I hope to leave today with genuine optimism and renewed confidence that, with the new Minister, our campaign will finally have its success. We cannot be satisfied with sympathy—it is not enough. We need action. The Government must finally bring this sorry state of affairs to a conclusion so that women can be assured that, if they need a hysteroscopy on the NHS, they will be in safe, caring and sensitive hands.

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)]

Wow. That was certainly a moving Adjournment speech. I thank the hon. Member, who knows she has my respect. We have been here together for many years, and I have to say that I am truly moved—more than moved—by the accounts of Rebecca, Vidya and Alison. Those stories are incredibly impactful because we know they are real and because, as women, we understand exactly what they are relaying in their experiences in a way that—I am sorry—chaps just do not.

The hon. Member referred to being here eight times. I think I have some good news for her in my response, and that is because she has brought this issue back here eight times. What I am about to say is in no small part due to her persistence. We all know that, in this place, very little happens overnight. The only way we achieve change is by doggedly continuing to push until something happens. I think she will be pleased with what I am about to tell her, but there is also something we will need her and the campaign to do to continue the momentum.

I thank the hon. Member for her continued campaigning, and I am delighted to respond to the debate. A hysteroscopy can be an essential tool in the diagnosis and treatment of conditions. What she referred to in, I think, Rebecca’s experience was a biopsy that is taken to look at tissues, for various reasons. Hysteroscopies are most important in investigating unexplained and distressing problems—they are a timely diagnosis tool—and can be used as a process for dilation and curettage. There are many reasons why women need them.

I am almost loth to read out these words—the hon. Member can tell I am going off script here—but the answer always is, “It’s a very quick procedure, it takes 10 to 15 minutes. If someone is in pain, 15 minutes is a very long time. Who would want to be in labour for 15 minutes? It is a long, long time.

I am almost tempted to say, “Shall we put our hands up to show who in here has been through a hysteroscopy?”, but maybe it is not appropriate for me to say that. I think we all can understand what the experiences are like. Patient experience is significantly varied, so there will be patients who say they did not feel anything and there will be patients who have stories such as those of the people the hon. Member has spoken to.

The NHS does not collect data on the number of women who experience pain— surprise, surprise—during hysteroscopy. However, I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of hysteroscopy patients have reported pain, and 25% is a considerable number. It is essential that women who are offered a hysteroscopy are given the information that they need to make that informed decision, which must include information about potential pain, options for pain management and alternative procedures that are available, such as a general anaesthetic.

I will address the points the hon. Member made regarding whether women are being offered appropriate pain relief and her concern that the national tariff—I completely agree with her here—creates an incentive for hysteroscopies to be carried out as an out-patient, without appropriate pain relief for those 25% of women. I will talk about three components to ensuring that women receive the care they deserve: evidence-based clinical guidelines, embedding the patient voice and monitoring implementation.

To minimise pain and promote best practice in hysteroscopy, it is essential that clinicians have access to guidelines. The Royal College of Obstetricians and Gynaecologists currently has a guideline, produced in 2011, which provides clinicians with evidence-based information regarding out-patient hysteroscopy. The guideline has an explicit focus on minimising pain and optimising the woman’s experience. It makes specific recommendations on practices that help to reduce pain.

I am told that the RCOG is now developing a second edition of those guidelines to ensure that the recommendations are based on the most up-to-date and robust evidence base. It is being developed jointly with the British Society for Gynaecological Endoscopy, and patient groups are represented on RCOG’s guidelines committee and the development group. Furthermore, a statement from the British Society for Gynaecological Endoscopy, which was published on RCOG’s website in 2018, also emphasises the importance of offering women from the outset the choice of having the procedure performed as a day-case procedure under general or regional anaesthetic as an alternative to an out-patient setting.

Alongside clinical guidance, I note the importance of patients’ voices, which are critical at every stage of the treatment pathway. Decisions on any treatment, including out-patient hysteroscopy with its benefits and risks, should always be discussed as part of the shared decision making between the clinician and patient. I understand that since the last parliamentary debate on this subject in December 2018, the NHS website, as the hon. Member noted, has been updated. I thank her for pointing it out and enabling that to happen. The website has been updated and RCOG has published a patient information leaflet regarding the procedure.

NHS England recommends that, as part of good practice, the Royal College of Obstetricians and Gynaecologists’ patient information leaflet, published in 2018, is provided to patients in advance, to assist with obtaining informed consent for the procedure. I imagine by that they mean that it is sent out with the appointment for the procedure or handed out at the clinic.

The patient information leaflet contains a lot of helpful information for patients. It explains what the procedure is and what is involved, what the patient should do beforehand and the questions they should ask health care professionals, the risks and alternatives, after-effects and what will happen following the procedure. The leaflet also recommends that patients take pain relief one to two hours before the procedure. After a hysteroscopy, I encourage any woman to read these valuable resources, along with the additional resources provided by their clinician. First, before the procedure, women must be able to speak to their doctor or nurse about what to expect and about pain relief options, including local or general anaesthetic, but, as we know and as the Cumberlege report has recently shown us, women’s voices are very often not listened to.

[Ms Brown]

I just point out that Rebecca turned up last week to an appointment, and there was no information. She did not even know that she was having a hysteroscopy. That was last week.

[Ms Dorries]

That is distressing to hear.

Women should also be advised that the procedure can be stopped at any time— but, although they are aware of that, that is an incredibly difficult decision to make. When we are in pain, we do not think rationally. It is important to put this on the record as women must be informed of their rights and have their voices heard. Finally, after the procedure, if the woman believes that there have been issues with the treatment that should be raised with the trust.

I want to talk about progress. NHS England advises that progress is being made through the implementation of clinical guidance. Within that, commissioners, and providers should advise service user feedback to be monitored to identify where the guidance is not being followed. As the hon. Member may be aware, women’s health is a personal priority of mine, and I have been looking at improving the experiences of women in the healthcare system since I arrived in the Department. As I recently set out in my statement to the House on the Independent Medicines and Medical Devices Safety Review, we cannot accept the status quo whereby it takes women so long to have their voices heard and for their concerns to be taken seriously. Whether we are talking about the Shipman or Paterson inquiries or the Cumberlege review or another maternity incident, it is sobering to reflect on the amount of inquiries that we have taking place that are about women-only issues. As I work with the team to evaluate every recommendation and every aspect of the Cumberlege review, I want to assure the hon. Member and the House that it remains an absolute priority of mine to tackle these issues.

I understand that the hon. Member has ongoing concerns with the best practice tariff. The aim of the best practice tariff is to encourage procedures in an out-patient setting where clinically appropriate. Out-patient procedures provide the patient with a quicker recovery, as well as allowing them to recuperate at home. I understand that NHS England and NHS Improvement will shortly be engaging with the sector on policy proposals for the 2021-22 national tariff. The tariff engagement document due for October publication will lay out NHS England and NHS Improvement’s initial proposals for the 2021-22 national tariff and will be followed by a statutory consultation. I understand, drawing on the momentum created by changes in the payments system this year due to covid-19, NHS England and NHS Improvement expect to propose an accelerated shift towards the use of a blended payment approach. This proposal would include the majority of services providing hysteroscopy. Blended payment would not differentiate between in-patient and out-patient procedures and, as such, the out-patient procedure’s best practice tariff would no longer be necessary. NHS England and NHS Improvement are currently planning to propose the removal of the best practice tariff from April 2021.

I hope the hon. Member will be pleased to hear this update, and I encourage her and patient groups to comment and contribute to NHS England and NHS Improvement’s proposals both in the tariff engagement document and the subsequent statutory consultation. I myself will be contributing to that consultation.

Once again, I thank the hon. Member for raising this important matter for discussion. She raised the issue of what was the women’s taskforce. I am not aware of any work that has taken place so far on hysteroscopies, but I will look into that. What I will say is that we have established something called the women’s health agenda, which has met this year. Sadly, it had to be stopped because of covid. We are already looking at restarting that agenda now and hysteroscopies will very definitely be on the table, as with all women’s procedures, when we are discussing the women’s health agenda. I really feel strongly that there is more we can do to ensure that we empower women to talk about their health, and I hope that we enjoy better outcomes as a result. Women are not listened to. They are not listened to in so many areas within health as a whole, and we have to change that. We have to ensure that a woman’s voice is heard throughout all the settings in the NHS.

Covid-19: BAME Communities

Lyn Brown Excerpts

Thursday 18th June 2020 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

I am grateful to my hon. Friend the Member for Brent Central (Dawn Butler) for giving us the opportunity to speak about this today. It is a pleasure to follow the sage, sad and passionate contribution from the hon. Member for Edinburgh West (Christine Jardine).

In Newham, we have statistically the second highest mortality rate from covid in the country. We have lost Ramesh Gunamal, who worked on the front desk at Forest Gate police station. We have lost Dr Louisa Rajakumari, who taught English at Kingsford Community School. We have lost Dr Yusuf Patel, a much missed GP from Forest Gate, and Abdul Karim Sheikh—sometimes a political opponent, mostly a friend, and a man always dedicated to the best for our communities. Those are just a few of the people who Newham and West Ham mourn deeply.

We know that deprivation doubles the risk from covid, and Newham is deprived—of that, there is no doubt. Like many of my friends’ areas, we have beautifully diverse communities, which means that they have been hurt massively by the pandemic. Those from our Bangladeshi community have twice the risk of death, and that is more than 12% of my constituents. Those from the Pakistani community have a 44% higher risk, which is 10% of us in Newham. Those from the Indian community have a 22% higher risk, which is 15% of us in Newham. Those from the black Caribbean and black African communities have a 10% and 6% higher risk, which is 4% and 11% of us in Newham.

Some 73% of us in Newham are from an ethnic minority, so we need this Government to act before we see a second wave. We need action so desperately that I have broken shielding to be here today so that I can demand it. The fact that I had to do so is wrong, but that is not nearly as wrong as the denial of equal protection for my constituents from this terrible virus.

I have written to the Minister for Women and Equalities, the Health Secretary and others about this twice. The first letter was sent more than six weeks ago. I do not think the urgency of my language could have been misunderstood. I wrote again two weeks ago, expressing, again, a desperate need for action. I have received absolutely no response of value. However, I was pleased to hear yesterday that there is finally going to be an urgent review of evidence and possible action on vitamin D deficiency. I hope we get that very, very soon, because if there is a second wave and we have constituents dying for the simple lack of a vitamin supplement, the Government know there will be a price to pay.

We know that it goes further than vitamin D. Staggeringly, despite the fact that black and minority ethnic communities are at greater risk of death, they are under-represented in clinical trials. Why? What possible excuse is there for that? In my humble opinion, it is incompetence, at the very best.

Let us look at the Government’s approach to covid-19 across this pandemic: it has been about slowing down its spread, which depends on two weeks’ full isolation. But in poor communities where there is no spare cash— there are no savings—excessive living costs have to be met week in, week out. Frankly, we all know that statutory sick pay just is not enough to keep people afloat, so sick people go to work. They put themselves at risk, they put the people on the tube with them at risk, they put the people who are on buses with them at risk, and they put their co-workers at risk, all because they are not paid enough money to enable them to stay at home like the rest of us can do, and recover. The Government have not even suspended the no recourse to public funds policy so that people can isolate. Why? Why do they not understand what these actions mean?

In Newham, many of us live in overcrowded homes—even my home feels a bit overcrowded at the moment with just me and my husband—which means that people at home cannot self-isolate. I accept that the Government are not going to be able to eliminate overcrowding overnight, but it would be great if they made a start. The fact that they cannot means that the other policies, such as track and trace, are really important. If we have a second wave, as I fear, and black and minority ethnic communities die in numbers out of all proportion again, we will be holding the Government to account for those excess deaths.

Children’s Mental Health Week

Lyn Brown Excerpts

Thursday 6th February 2020 Commons Chamber

[Preet Kaur Gill]

The hon. Gentleman makes a really important point. Far too often, we do not recognise the work that schools are doing, and the charity sector, especially, has contributed significantly. Importantly, the Green Paper does not recognise that.

Today I want to focus on the public health approach, utilising early intervention and prevention. This is far too often overlooked, but it is a vital part of any attempts to tackle the crisis we are facing. Furthermore, if we fail to support children at an early stage, we will inevitably feel the impact further down the line when emergency services will be forced to step in. That is what we are seeing at the moment, and change clearly needs to happen.

So what am I talking about and what does it look like in practice? Let us take local government. Because of huge cuts by national Government, 60% of local authority areas have seen a real-terms spending drop on mental health services for children that come under the “low level” bracket, which includes early intervention for things like eating disorders and depression. Or let us look at our creaking and failing criminal justice system. Research by Revolving Doors found that children of offenders are three times more likely to have mental health problems or to engage in antisocial behaviour than their peers—and, as I said, almost all 15 to 21-year-olds in custody suffer from a mental health disorder. Reducing reoffending and the number of parents experiencing incarceration is not just a good in itself but may prevent their children from having mental health problems and reduce the likelihood that the child is involved in offending in the future. Will the Minister explain why, in answer to my written question, the Department for Health and Social Care admitted last week that it had

“not made a formal assessment of the adequacy of mental health services or mental health assessment in Young Offender Institutions”?

Let us take community-based mental health services. The Care Quality Commission, in its review of healthcare and adult social care in England in 2018-19, found that 21% and 10% of community-based mental health services for children and young people are rated as “requires improvement” or “inadequate” for the responsive key question.

Take schools, which the hon. Member for Strangford (Jim Shannon) mentioned. Schools in Birmingham are facing a funding shortfall of more than £90 million in 2020, but they are still working hard to fund their own mental health support or arranging peer mentors. Why are they doing that? One reason is that waiting times for referrals—if the referral is even granted—are far too long. Last year, I conducted a survey of schools in my constituency of Birmingham, Edgbaston and discovered that 90% had seen an increase in staff and students suffering from mental health problems. That is not sustainable without a substantial increase in support for our schools. Take looked-after children. According to Government data, they are nearly five times more likely to have a mental health disorder than their peers.

Take poverty. The TUC found that poverty in working households has increased by 800,000 since 2010. Poverty contributes to mental wellbeing. The Centre for Mental Health’s Commission for Equality in Mental Health found that children from the poorest 20% of households are four times more likely to have serious mental health difficulties by the age of 11 than those from the wealthiest 20%.

[Ms Lyn Brown (West Ham) (Lab)]

My hon. Friend’s speech is resonating with me. In the conversations I have had with primary school teachers, they talk about the stress that children as young as six, seven and eight are under because their families are struggling to pay the rent, despite the fact that the parents are at work. Poverty is a major driver of this. We have to tackle both things—the mental health needs of our young people, but also the poverty in which they live.

[Preet Kaur Gill]

My hon. Friend is right; poverty has consequences.

Take social security. The Government’s flagship policy of universal credit is not only driving more households into poverty but is creating a climate of fear and threats. Those are all factors that lead to poor mental wellbeing.

No child should have to reach crisis point before they are able to get help with their mental health. We cannot pretend that the causes of mental health are simple or that they are not impacted and exacerbated by inequalities and injustice. The Centre for Mental Health has rightly raised the futility of funding mental health services that support symptoms if those resources are diverted from preventive measures to tackle poverty and inequality, including policies in the criminal justice system, education, public health, youth services, housing and social security.

Those sectors and services are all in vital need of long-term, sustainable support, and that is why I am calling on the Minister to ensure that a public health approach is introduced that promotes mental wellbeing, prevents future mental health problems and supports recovery from mental health issues. There are different ways to achieve that, but I would like to ask the Minister to take the first step and, with a reshuffle imminent, ask the Prime Minister to introduce a children’s wellbeing commissioner, or similar, with real teeth, powers and resources to work across Departments.

Oral Answers to Questions

Lyn Brown Excerpts

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

Of the original 2015 cohort that the hon. Lady mentioned, 6,325 people have been discharged and 476 beds have been decommissioned, but the thing is that people are still coming in. The only way we can achieve permanent, long-term cuts is if we invest in community health. That is why the long-term plan commits to an extra £4.5 billion a year for community health. Local providers are expected to use some of that to develop the right specialist services in the community to reduce avoidable admissions.

[Lyn Brown (West Ham) (Lab)]

9. What recent assessment he has made of the efficiency of decision making by the National Institute for Health and Care Excellence.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Wherever possible, the National Institute for Health and Care Excellence aims to publish recommendations on new drugs within a few months of licensing and now publishes draft guidance on cancer drugs even before licensing. Many thousands of patients have benefited from rapid access to effective new drugs as a result.

[Lyn Brown]

The Secretary of State will know that Maryam is now nine months old. We have been waiting nine long weeks for NICE to announce a decision that I am told it has already made. Spinal muscular atrophy babies have been waiting 16 months for the care they need, which is longer than many SMA babies live without treatment. There is another closed-door meeting tomorrow. If NICE finally decides to provide Spinraza on the NHS, how long will it be before Maryam and the other babies get their first dose?

[Matt Hancock]

The hon. Lady rightly raises an important case, and I have met her about it and followed it closely. As she says, there is work ongoing and happening this week to try to make progress. NICE is currently developing technical appraisal guidance on the use of the drug Spinraza, to which she refers. We are working to ensure that we can get it right.

NICE Appraisals: Rare Diseases Treatments

Lyn Brown Excerpts

Thursday 21st March 2019 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

I am sure hon. Members will not be surprised to hear me talk again about baby Maryam, my seven-month-old constituent with spinal muscular atrophy type 1. Without treatment, Maryam will have only a few more months to live. She is waiting for NICE to announce a decision to allow access to Spinraza, the drug that she and other babies with the condition so desperately need.

I start by thanking my hon. Friend the Member for Blaydon (Liz Twist) for securing this important debate; the Daily Mirror, especially Pippa Crerar, for telling the stories of SMA families; the Newham Recorder, the campaigning newspaper, for its continued coverage and encouragement; and the amazing members of the local community in West Ham for their support. Councillor Mas Patel has been brilliant, as has Kevin White and many others who have taken the plight of this little baby into their hearts.

Most of all, I pay tribute to Shakil, Maryam’s father, and all Maryam’s family who have steadfastly campaigned despite knowing that, when we finally get access to Spinraza in England, it could so easily be too late for Maryam.

As we know, SMA1 is an awful disease. It is a progressive muscle-wasting condition, and for a baby it causes difficulties with breathing, swallowing and gaining weight. Babies with SMA1 may not even be able to cry aloud. Spinraza is an effective treatment for SMA. With this treatment, babies and children are living longer; they are even crawling and walking. I am told that by last August, when NICE first met to consider funding Spinraza on the NHS, none of the babies who had been treated with it in the UK had died as a direct result of their SMA. The drug was so effective that the trials stopped early, yet NICE refused to approve Spinraza at that August meeting, or at the second meeting in October or in November.

In November, the expanded access programme, which allowed treatment with Spinraza while negotiations were ongoing, was closed—Biogen, the drug company that developed Spinraza, closed it. So when Maryam was diagnosed in December last year, she had no access to this drug. Even if it could have been afforded privately and even if my community in West Ham had fundraised for it—I can tell Members that an awful lot of people have wanted to do just that—she could not have got it. We are not talking about huge numbers; we are talking about fewer than 100 babies a year. Treating this condition should not break our bank—it could not, surely.

NICE met again two weeks ago—we held a vigil while it was making its decision—but I am told it could be three or more weeks yet before that decision is known. This is callous. Making families, making Maryam and making the other babies wait this long is callous. The NICE approvals process for Spinraza has now taken 14 months. That is longer than many of the babies with SMA1 can be expected to live without the treatment. At the same time, agreements have been reached on Spinraza in the United States and in 25 European countries, including Scotland, Germany, Italy, Lithuania and Romania.

NICE has failed Maryam and all the other babies with SMA, but others are culpable, too. The closure of the access programme no doubt saved Biogen some money, but I am sure that it was closed to increase pressure on NICE as well. I cannot say that that is definitely true, but what I will say is that if it is true, the suffering of tiny babies, and the pain and suffering of their families, too, has been used in the service and pursuit of profits. I now believe that our whole system of for-profit medical research combined with public healthcare encourages this kind of brinksmanship, it encourages delaying tactics and it encourages the exploitation of sick children and their families.

Let us also consider the actions or inaction of the Government. I am sure hon. Members will recall how in the spring statement the Chancellor talked of a

“proud, successful, outward-looking nation, with no limit to our ambition and no boundaries to what we can achieve.”—[Official Report, 13 March 2019; Vol. 656, c. 352.]

He bragged about

“the single largest cash commitment ever made by a peacetime British Government”.—[Official Report, 13 March 2019; Vol. 656, c. 346.]

This was for the NHS. Surely we can afford to help these babies, too. Currently, we are the fifth richest country in the world, yet we are withholding vital medical treatment from babies. This is medicine that 25 other European countries, including some much poorer than we are, are willing to provide. What does that say about us? What does that say about our values? What kind of a country have we become?

I have asked the Prime Minister to act—twice. I have asked the Health Secretary to act. As far as I can see, nothing has happened. I hope that Conservative Members will forgive me when I say that I thought the Prime Minister’s response to me last week was cold; it was more about defending an outdated process than about understanding and empathising with the desperate plight of Maryam and her family. Let us remember that 25 European countries already have access to this drug, We do not, yet it seems to be nothing to do with the Prime Minister.

[Neil O’Brien (Harborough) (Con)]

The hon. Lady is making a good and powerful speech. Two of my constituents, Mark and Panna Wilson, are in a situation similar to that of her constituents: their son Aadi is only three years old and is regressing every day because he, too, has SMA, which is a terrible condition. They told me that

“without access to new treatments, each and every day is a step, not towards an exciting future, but towards a painful and dark place.”

The hon. Lady is right, and I hope that we will find a new route to the approval of Spinraza in this country. The route it is currently going through is intended for much more generic medicines and it has not been put through the route for rare medicines. We need either to put it through the route for rare medicines or to find or invent a new mechanism so that we can get treatment for these people. As she points out, this is a rich country: we must be able to save these babies and toddlers.

[Lyn Brown]

The hon. Gentleman is absolutely right. This is a political issue—what we are discussing today is political. It is about which of our constituents get access to which medicines, and when; who our public healthcare service helps with our public money; and who we allow to die without help.

Members on both sides of the Chamber have recently urged the Government to use their Crown use licensing powers in the case of Orkambi. Those powers can get around medicine patents when pharmaceutical companies are simply refusing to deal honestly with the NHS, and they are an option. There are always options for the Government if they wish to use them, but they seem to be content with voicing frustration. They do not do anything—they will not even threaten to do anything that might help. If the Patents Act 2004 is not working, as Ministers have said, we need to do something to replace it. Maryam’s family and others want action now. They need Spinraza now; when will they get it?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Let me add my congratulations to the hon. Member for Blaydon (Liz Twist) on securing the debate. I was not familiar with the north-east massive, although I am now. I was familiar with the individual component parts of the north-east massive, especially my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), but I have not seen them as a collective before. I must say that they hunt well as a pack.

I know of the work of the hon. Member for Blaydon, who chairs the all-party parliamentary group on phenylketonuria. We have discussed these matters before, in Westminster Hall, and I do not doubt that we will discuss them again.

Other Members have spoken passionately today, on behalf of their constituents, about the importance of access to new medicines. As the hon. Member for Dudley North (Ian Austin) rightly said, Members are doing their job, and I am doing mine: as requested, I have listened very carefully to the debate. I thank my hon. Friend the Member for Reigate (Crispin Blunt), and the hon. Members for Wolverhampton South West (Eleanor Smith), for Bristol East (Kerry McCarthy), for West Ham (Lyn Brown), for Liverpool, West Derby (Stephen Twigg), for Heywood and Middleton (Liz McInnes), for Dudley North, for South Shields (Mrs Lewell-Buck)—part of #massive—for Strangford (Jim Shannon) and for Motherwell and Wishaw (Marion Fellows), who speaks for the Scottish National party.

The hon. Member for Liverpool, West Derby touched on the subject of cannabis, and I will happily write to him about that in more detail if he wants. As he knows, the all-party group report came out yesterday. I have not had a chance to look at it yet; I am aware of it, obviously. The Government changed the law and specialist doctors can now provide cannabis-based medical products where there is clinical benefit. To support doctors in this—because the politicians are ahead of the clinicians on this one—we asked NICE to develop new clinical guidelines and we asked Health Education England to provide additional training, while encouraging more national research to develop the evidence base in this. I have said before and I shall say again that I am very clear that we need to provide more support and encouragement to commissioners in this space because, as I said, politicians are ahead of the clinicians on this one.

Everyone has spoken incredibly passionately and there has been very little politics in the debate, which has been excellent, at the end of this week. It is very good to hear Parliament discussing something else, which of course it does all the time; it is just that that is never reported— I dare say this will not be, either.

The Government share the view of everyone in the House that it is in the interests of all NHS patients that we have the best system in place for making evidence-based decisions on whether new medicines are routinely available. Of course it is easier when one is on the Back Benches to just say the system is hopeless, but we have to work with the system we have, or change it. We inherited the NICE set-up. It was mentioned in the first Labour Queen’s Speech, in ’97. It was created in 1999 in a Delegated Legislation Committee by then Health Minister of State John Denham, who is a good man. He set it up. When he did so, he said it was set up to make independent, evidence-based recommendations for the NHS on whether drugs represent an effective use of NHS resources.

NICE is widely recognised as a world leader in the field of health technology assessments. Its methods and processes have been developed and continuously refined over the last 20 years through periodic review and engagement with stakeholders. Politicians are not in the middle of those decisions, and rightly so; that is how the system was set up by the aforementioned Mr Denham. Maybe the hon. Member for Heywood and Middleton was right to trust her instincts—

[Lyn Brown]

Will the Minister give way?

[Steve Brine]

No, because the hon. Lady has had her say and I am going to have mine in the short time I have. If I have some time—

[Lyn Brown]

It is on behalf of my constituents.

[Steve Brine]

Mr Deputy Speaker, I think the hon. Lady has spoken on behalf of her constituents a lot today, and very well. [Interruption.] I do not think, given the tone of this debate, we need to get unpleasant in here. [Interruption.] I will address the points in my speech and, if the hon. Lady does not like that, I am sorry, but I do not think anybody watching this, least of all the families affected, need to hear that tone.

As a result—

[Lyn Brown]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Whether the Minister wishes to give way is up to the Minister and we must let him finish his speech.