Autism and Learning Disability Training: Healthcare Professionals

Baroness Brown of Silvertown Excerpts

Monday 22nd October 2018 Westminster Hall

[Daniel Zeichner (Cambridge) (Lab)]

I beg to move,

That this House has considered e-petition 221033 relating to autism and learning disability training for healthcare professionals.

It is a pleasure to serve under your chairmanship, Dame Cheryl. You are an expert in this issue and have campaigned on it for many years. I am sure you wish you could be contributing to the debate.

The petition text is particularly important, so I shall start by reading it to inform hon. Members fully and to put it on the record. Paula McGowan, the petitioner, wrote:

“My son Oliver was only 18 when he died in hospital on 11 November 2016. I believe his death could have been prevented if his doctors and nurses had received mandatory training. He had autism and a mild learning disability, and they weren’t trained to understand how to make reasonable adjustments for him. One in four healthcare professionals has never had training on learning disability or autism. This is unacceptable. Two thirds want more training, and one in three think a lack of Government leadership is contributing to the problem of avoidable deaths. The Government must ensure all healthcare professionals get mandatory training to address the huge health inequalities facing people with autism and a learning disability.”

That is the wording of the petition which I speak to, and I open the debate on behalf of the Petitions Committee. I point out to the many people watching or following the debate that in the main Chamber, the Prime Minister will shortly make a statement on last week’s EU summit and that many hon. Members who would have liked to contribute to this important debate have faced a difficult choice, which is perhaps why we are relatively few.

I will start with some background. In 2016, Oliver McGowan died in hospital. He was autistic and had a mild learning disability, mild cerebral palsy, and partial seizures. I will read his mother’s account of what happened. She is waging a powerful and brave campaign. As she told me, mothing can bring Oliver back, but she wants to ensure that lessons are learned properly, so that in future, others will be safer. She would very much have liked to deliver the account herself, but under Parliament’s current rules, it is not possible for her to speak in the debate. Her account is lengthy, but it is important that it is heard in full. This is Oliver’s story, in his mother’s words:

“Oliver enjoyed college, playing football and was an amazing athlete, in training to become a Paralympian. Oliver loved life and being with his family. He was bright, achieving GCSE and BTEC qualifications, was a member of the school council and head prefect. He was a fit and active teenage boy and yet on the 11 November 2016, aged 18, he died in Southmead hospital, Bristol, in circumstances that his family believe were entirely avoidable. When we brought him to A&E with absence type seizures, we thought he would be in hospital for a couple of days at the most, and he would go to college the following week as planned.

Oliver had mild hemiplegia, absence type partial seizures and a very mild learning disability as a result of having meningitis as a baby. He also had high functioning autism. His additional needs were not obvious to most people, but anxiety was a challenge for him.

When Oliver turned 17, his absence type seizures increased and on several occasions he had to spend time in hospital for investigations. His seizures caused him to become anxious, scared and agitated and due to this, his high functioning autism became more obvious.

In October 2016, aged 18, Oliver was admitted to an adult hospital having absence type partial seizures. Oliver explained the seizures as being like several bees buzzing down one’s ears whilst you are trying to think and go about your day; incredibly frustrating and distracting. He was conscious throughout and was very scared and anxious.

A&E staff were presented with Oliver’s hospital passport, detailing how his autism and learning disability affected him and how to make reasonable adjustments. It also detailed his allergies to antipsychotic medications. This was not read but placed in a drawer without a glance.

Several doctors were talking to Oliver at once, using complex language that was hard to understand. When Oliver wanted to walk around (a normal part of his seizure activity) he was restrained by several members of staff, which heightened his anxiety.

Oliver had said clearly to the ambulance staff, he was happy to go to hospital, but he did not want to be given antipsychotic medicine, giving sound reasoning, stating ‘they mess with my brain and make my eyes go funny’. He said this again in the hospital, as did we, providing letters from previous consultant doctors explaining Oliver’s reactions to medications and busy hospital environments.

Previously, when these exceptionally strong medications had been trialled to help Oliver’s anxiety in seizure, we had seen Oliver’s behaviour change in a way we had never seen before: hallucinating, tearing at his skin with significant increase in seizure activity. We knew that Oliver was not psychotic or mentally ill. Previous senior psychiatric consultants had said the same thing, that Oliver was not psychotic or mentally ill but a teenager who had high functioning autism and a mild learning disability impacted by partial seizures. They wrote he was sensitive to medications, especially benzodiazepines. The doctors in A&E wrote ‘antipsychotic medication’ in red in the allergies box on all of Oliver’s ICU patient 24 hour care charts. The A&E doctor also sent an email to all doctors treating Oliver that he was sensitive to all antipsychotic medications.

Oliver was sedated and placed on life support in A&E to investigate his seizures. A few days later, whilst Oliver was still on life support and against Oliver’s and our strong wishes, he was given an antipsychotic drug called Olanzapine. Doctors said it was to control his anxiety when he woke up, even though we explained to them that when any seizures had finished Oliver immediately returned to his normal mild mannered self.

Oliver never woke up; the Olanzapine caused him to develop Neuroleptic Malignant Syndrome, or NMS. His brain swelled so badly it was bulging out of the base of his skull causing irreversible brain damage. We were told that Oliver would be blind, deaf, no memory, no speech and would be reliant on breathing machines including tube fed.

Oliver died on Armistice Day, a fitting day given Oliver’s father is a serving senior officer in the Air Force and Oliver had lived his whole life as a military child. We can all agree that Oliver was certainly a very brave young man.”

Paula goes on to say:

“If the doctors and nurses had been trained to understand how to make reasonable adjustments for him (someone with autism and a mild learning disability), they would have known how to adapt the environment to meet his needs. There would have been no need to use a ‘chemical restraint’ and he would not have had the NMS reaction to this type of medication.

If doctors and nurses had had the training to support Oliver’s medical, social and emotional needs effectively, they would have known how to adapt their communication, using humour to settle his anxiety in a crisis, and de-escalate the situation further. They made a decision about how to manage potentially challenging behaviour as Oliver came out of sedation. They did not properly explore alternatives to using antipsychotic medication. A senior safeguarding nurse had advised a non-pharmaceutical approach. There was time to do this and consult with other professionals who knew Oliver best and were treating him in the community, as he was sedated and stable in intensive care. This did not happen although there was time.

I believe that ignorance of learning disability and autism cost Oliver his life, and we must never allow this to happen again. I believe that if Oliver hadn’t had a diagnosis of autism and a learning disability, and presented in hospital with the same symptoms, he would not have been prescribed an antipsychotic. Oliver’s death is not an isolated case, with evidence in relation to learning disability showing 1,200 avoidable deaths every year, and women with a learning disability dying nearly 30 years earlier than the general population.”

[Lyn Brown (West Ham) (Lab)]

I can see that my hon. Friend is coming to the end of his peroration, so I thought I would intervene briefly. I understand that the Government have announced a review, but does he not agree that something a little more urgent is needed?

[Daniel Zeichner]

I am not coming quite to the end, but I have almost reached the close of Paula’s statement. I think my hon. Friend will understand from the suggestions later in my speech that I absolutely agree with her conclusion.

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

Thank you for calling me to speak, Dame Cheryl. I recognise your expertise and knowledge in this area. As one of the leading Members of the House, you have worked tirelessly to represent the rights of those with autism, and you took the Autism Act through Parliament. My comments will pale in comparison. Your position today prevents you from speaking, but I want those watching the debate to know how indebted Members on both sides of the House are to you for your efforts.

I speak in my capacity as the Member of Parliament for Kingswood, near Bristol. My constituent, Paula McGowan, has worked tirelessly and courageously to highlight the tragic death of her son, Oliver McGowan, on 11 November 2016. Paula’s work to establish Oliver’s campaign and call for mandatory autism and learning disability training for NHS professionals led to the creation of a petition, which had been signed by 51,310 people as of around 3 pm. I am extremely grateful to the Petitions Committee for scheduling this debate on that petition.

I speak as Paula’s local representative, but what she has achieved in the face of such extreme grief and anguish is so remarkable that, in all honesty, she should be telling Oliver’s story in this debate. That story is awful and harrowing, but it needs to be told. I am grateful to the hon. Member for Cambridge (Daniel Zeichner) for putting Paula’s testimony on the record. She sent me some additional personal words. It is important that I place those words on the record, too, not only for the benefit of Members present but so that they stand as a testament to Oliver and so that his death is remembered eternally in the House’s official record, Hansard.

Paula states:

“From the moment Oliver was born, we knew that he was special and our love for him was overwhelming. Oliver was born premature and developed meningitis at three weeks of age. He was very ill and we were told they did not expect him to survive. However, Oliver began to recover. Everybody who came into contact with Oliver warmed to him and could not resist spending time with this baby.

Sadly, Oliver developed a second episode of meningitis and was incredibly ill. Amazingly, against all odds and many months of hospital treatment, Oliver’s strength and determination shone through and he survived once again, and as always with that beautiful heart warming smile that everybody was drawn to. Oliver—as a result of an infarction caused by the meningitis—was left with mild cerebral palsy, focal epilepsy and later on a diagnosis of high functioning autism.

Oliver’s disabilities did not hold him back. He had a can do attitude and amazed everybody with his achievements. He played for the South and North West Centres of Excellence England development football squads. He was a registered athlete with the Power of 10 and was ranked 3rd best in the country for athletics. Oliver was a member of Team Bath and was being trained to become a Paralympian.

Oliver was a natural leader and became a prefect and chair of the school council, later college. He attained several GCSE and BTEC examinations. He went on to attend National Star College in Cheltenham. Their opinions of Oliver were very complimentary, writing how he was often mistaken to be a member of staff; how friendly and kind he was, supporting students who were less able than himself; his wicked sense of humour; and the aspirations they had for him to start a sports course at a local ski centre.

Oliver brought so much happiness and fun to our lives; he always saw the best in everything and taught all of us how to look at things differently. Oliver never failed to light up a room with the sound of his laughter. He wanted to make everybody happy and did his best to achieve that. Despite his limitations, he never complained or asked, ‘Why me?’ He accepted everything and always with a smile. His courage and enthusiasm was inspirational. We were told by his neurologist that Oliver had a full life expectancy and it was expected he would live an independent life with a little support.

On 15 October 2015, Oliver was admitted to a children’s hospital, having what we—his parents—and college staff recognised to be simple partial seizures. These caused Oliver to be anxious, agitated and confused. After several weeks of tests Oliver was discharged home and given sertraline—an antidepressant medication—to treat his anxiety. We were surprised as Oliver was not depressed. Once this medication was increased, it caused a change to Oliver’s mood and increased his seizures greatly.

He was admitted back to the same hospital on 15 December 2015, but this time was given antipsychotic medications. The doctors were misunderstanding Oliver’s autistic behaviours to be an ictal psychosis, and his normal autistic obsessions to be delusional behaviours. The effect on Oliver was catastrophic. Oliver’s seizures threshold and anxiety deteriorated and he was eventually held against his will under the Mental Health Act, section 2. We challenged this on numerous occasions, stating we felt it was the drugs that were causing the changes to Oliver’s mood and seizures.

A psychiatric bed could not be found and doctors decided to remove the antipsychotic medications. Within days Oliver’s mood and seizure activity improved and he was discharged back home into our care. A community psychiatrist wrote Oliver was sensitive to antipsychotic and benzodiazepine medications.

On 15 April 2016, Oliver was readmitted back to the same hospital having simple partial seizures and was anxious. Sadly, Oliver was again given antipsychotic medications, one or more of which caused a serious side effect called oculogyric crisis. He was left like this for several hours as the doctor at first believed it was behavioural. After four hours he was given procyclidine medication. Again, Oliver’s mood changed significantly. He was hallucinating, having up to 30 seizures a day—something we had never seen happen—and had problems urinating, extreme high blood pressure readings and sweating, all of which were linked to medications.

We strongly believed the drugs were the cause of the decline in Oliver’s mood difficulties. It was obvious that doctors and nurses had little to no understanding of autism and how autistic behaviours could present in a person with ongoing seizures. When in seizure, Oliver was always fully conscious, and because he had no control of the seizures they caused him to be frustrated and scared.

At my request, Oliver was transferred to a specialist adult hospital, which I thought would have understood Oliver’s epilepsy better. Oliver had been provided with a letter stating his reactions to previous medications. Sadly, the use of physical restraint was increased with up to eight staff being involved. Oliver was suddenly not allowed any privacy with his personal care. He had three staff sat around his bed and he was kept in a darkened room. Oliver was very frightened and he told me just how scared the staff were making him feel.

Oliver was again given different antipsychotic medications and consequently detained against his will and transferred to a specialist mental health ward. The different approach from skilled staff allowed Oliver to improve within days. The words from staff including doctors from the unit were that Oliver was not psychotic or mentally ill, and that his placement there was a total misuse of the Mental Health Act. They reduced all antipsychotic medications and Oliver was discharged after a few days into the care of a specialist learning disability team, again with a letter saying that he was sensitive to antipsychotics and benzodiazepines.

The team was very supportive and specialised in people with autism and learning difficulties. A consultant psychiatrist in learning disability wrote that Oliver was not psychotic or mentally ill. He believed Oliver’s behaviours were a result of autism and mild learning difficulties and an environment that was not adapted to meet his needs.

Sadly, on 16 October 2016, Oliver had a cluster of seizures and was admitted to an adult general hospital. Oliver told ambulance staff and also doctors in A&E not to give him antipsychotic medications as they messed with his brain and made his eyes go up. He was reassured by doctors they had no intention of using those medications. We gave doctors a folder of supporting letters stating Oliver’s reaction to antipsychotic medications, and it was subsequently written in bold red ink on Oliver’s medical care sheets he was intolerant to all antipsychotics.

Oliver was intubated. The safeguarding officer was consulted on how to manage Oliver’s anxiety when sedation was reduced. His advice to the doctors was a non-pharmaceutical approach and to use soft handcuffs. We were told we should be present as we would be able to reassure and comfort him. We were told that most people would become highly anxious when woken from being sedated. This advice was not listened to and sedation was reduced without our presence. According to staff, Oliver became anxious. He would have felt scared waking to find tubes in his throat and in unfamiliar surroundings without familiar faces. Full sedation was increased.

We were consulted by a neuropsychiatrist who had met Oliver for two 10 minute appointments in the community. She asked us about giving Oliver an antipsychotic. We made it very clear about Oliver’s previous reactions to this type of medication and that she did NOT have Oliver’s or our permission to administer any antipsychotic medications. Despite this, Oliver was given the antipsychotic medication olanzapine at a low dose that evening without our knowledge. The next day, we again made it clear to all doctors and nurses that they did not have Oliver’s permission to administer this.

Oliver, over the next few days, developed a temperature of 42^°. Because doctors said his liver function was elevated he was not given any medication to control the temperature other than a light blow up mattress filled with cold air. This was not effective. Doctors could not understand the decline in Oliver’s condition and they sent him for a scan of his liver and lungs. Unfortunately, it was several more days before they scanned his brain. It was so badly swollen it was bulging out the base of his skull. We were told Oliver had neuroleptic malignant syndrome, a rare but serious side effect of antipsychotic medications.

A week later, the decision was made to turn Oliver’s life support machines off. Oliver passed away several days later on 11 November 2016: Armistice Day—poignant given we are a military family.”

Paula continues:

“Oliver’s was a life wasted due to doctors not communicating effectively with family and practitioners who knew him well and who were in daily contact with the hospital. We believe the doctors were arrogant and ignorant and believed they knew Oliver better than his parents. They did not consult wider, when there was ample opportunity to do so.

We have since been told by the doctor who administered the antipsychotic drug that she would have given it regardless of our wishes, as she believed it was in Oliver’s best interests, and she would do the same thing again given the same situation knowing that Oliver has lost his life. We understand that many people receive the medications that Oliver was given, often for managing a mental health condition, and do so without suffering the effects that Oliver had. In Oliver’s case, we had clear understanding that he was sensitive to these medications and we believe they should not have been prescribed.

We believe that Oliver’s death was very preventable. We believe that Oliver was given excessive drugs due to medical staff not understanding autism impacted by seizure activity. They did not ever try to adapt the environment to meet his needs, but used excessive restraint methods. They failed to make any communication with community-based professionals who were working with Oliver on a daily basis and knew him well.”

A later inquest into Oliver’s death concluded that the care Oliver received in the lead-up to his death was “appropriate”. It stated that despite warnings from Oliver and his parents, the development of complications from medication could not have been predicted. As a local Member of Parliament, I was in contact with Paula after Oliver passed away to support her when she approached the local police and coroner’s office to ask for an investigation into the death of her son. I will continue to offer all the support that I can.

In spite of that inquest’s conclusions, the Government’s learning disabilities mortality review programme, which investigated Oliver’s case, highlighted the challenges that vulnerable people such as Oliver still face in gaining access to appropriate care. There remain serious disparities in the quality of health support and care received by people with autism and learning disabilities. The evidence shows, as has already been mentioned, that people with learning disabilities die at a far greater rate than others. Often, that can be prevented with the right care and support and better awareness and training.

Recent reports from Mencap, which has been recognised for its ongoing efforts and campaigns, found that one in four doctors and nurses has never had any type of training on learning disability. Clearly, that is unacceptable. Every person should receive the same high quality of care, whether or not they have a learning disability. Although we have made progress in our collective understanding of autism and learning disabilities, much more needs to be done to ensure that vulnerable people receive the right support from our healthcare system when they need it most. I am encouraged that the Government have accepted all the recommendations from the learning disabilities mortality review, including recommendation 6, which proposes the introduction of mandatory training for all health and care staff. I am also pleased that they have committed to delivering that training in partnership with people with experience, including families and parents like Paula.

I welcome the Government’s proposals for a consultation on options for delivering that essential training to staff, which is due to be completed by the end of March 2019. With that in mind, I would welcome it being arranged for Paula to meet the Minister to discuss Oliver’s campaign and its consequences, and for this work to continue. I would also welcome the Minister and the Department continuing their close working with Mencap, the National Autistic Society, other charities and relevant organisations, and indeed Members of Parliament such as the Solicitor General, my hon. and learned Friend the Member for South Swindon (Robert Buckland)—he is in his place but his ministerial role affords that he cannot speak in the debate—who have personal experience of autism. It is right to draw on that.

[Lyn Brown]

I have listened to the hon. Gentleman and have been really affected by his speech; I am sure he has been affected as the local MP. I pay tribute to him for how he is putting his case, but does he not agree that the review is unnecessary and that what we actually need is some action now?

[Chris Skidmore]

I agree that we need clarity, not only extra guidance. The review is one step in a journey that has yet to be completed. I own up to this, having been a Minister previously: there is a commitment to looking at guidance and training, but I am concerned with the implementation. Going forward, we could produce all the training, guidance and material we want, but how will we monitor the outcomes? What are we seeking to achieve?

A couple of months into my job as a Minister in the Cabinet Office, having previously been secretary of the all-party parliamentary group for disability as a Back Bencher, I wanted to look at how we could increase and encourage electoral registration among those with learning disabilities. The answer I got was, “Well, there is guidance out there already, Minister. The Electoral Commission has produced documentation.” However, it was patently clear to me that it was not being implemented in polling stations across the country. I would like to see a commitment from the Minister not just for consultation and guidance to be produced but to ensure that we have accountability. The Care Quality Commission must be involved, and people must be judged on the standards introduced; this must be followed through.

In conclusion—this may chime with what the hon. Member for West Ham (Lyn Brown) said—I return to the words of Paula McGowan:

“If the guidelines and principles from NHS England’s STOMP—stopping the over-medication of people who have learning disabilities—project had been followed with healthcare professionals being able to listen to family and specialist colleagues, then we firmly believe that Oliver would still be here today. We believe that Oliver’s premature death should be in the public’s interest, and I challenge the Government to: ask people with a learning disability, autism or both, their families and carers for their opinion and concerns about treatment; listen to all involved and show respect to those opinions and concerns; and do something about it and work in partnership with us. Specifically, NHS professionals who provide specialist care in learning disability and autism should: put people at the heart of all decision making; respect our point of view; not make decisions without us; and enable us to understand complex decisions in a way that is relevant to all and provide information and explanation.

In particular, check if your patient has a hospital passport. Respect your patient by getting down to the same level as them—don’t stand if your patient is sitting. Give them personal space. Modify your language so that it is clear and precise, and don’t use medical jargon. Check your patient has understood what you are saying. Effectively listen to your patient. Give your patient time. Make them feel valued and included in their treatment plan. Mostly”—

above all—

“offer reassurance. In addition, liaise with healthcare colleagues in general hospitals to raise awareness and understanding of learning disability, autism and the principles of STOMP. And, above all, do everything in your power to prevent a story like Oliver’s from having to be told again.”

From my own point of view, I hope that we can all work together to ensure that we do not have to stand here again, making the case for change. Let us support Oliver’s campaign and ensure that his death marks a watershed moment and a turning point in how we treat those with autism and learning disabilities in the NHS.

Perinatal Mental Illness

Baroness Brown of Silvertown Excerpts

Thursday 19th July 2018 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

I beg to move,

That this House has considered perinatal mental illness.

It is a pleasure to serve under your chairmanship, Mr Davies. I and my colleague on the Select Committee on Health and Social Care, the hon. Member for South West Bedfordshire (Andrew Selous), are delighted to have secured this important debate, and I thank the Backbench Business Committee for granting it.

Nothing can prepare someone for the challenge of becoming a new parent—the sleepless nights, the new responsibility and the feeling that they suddenly have to put their old life on hold. As I have found since becoming a parent, a few months before my 40th birthday, raising a newborn child can be hugely rewarding. There is little that compares with the joy of seeing a child grow and develop. For most of us, it is a deeply fulfilling experience. Still, becoming a parent can have a dramatic impact on many people, in terms of both the stresses they experience and the impact it has on their relationships and their emotional wellbeing.

I will talk about how the Government can act to improve the lives of thousands of mothers in England who do not receive adequate support for perinatal mental health problems. The perinatal period is the time during pregnancy and the run-up to a birth, and the time immediately following the birth of a new baby. As a general practitioner as well as a parent, I have worked to provide mothers and newborn babies with the support and care they need in the perinatal period. It is a crucial time not only for the mother, but for the development of her child. It is also a time when great pressure is placed on mothers to care for their baby and simultaneously to be happy, excited and on top of life.

According to the mental health charity Mind, about one in five women experience mental health problems during pregnancy or in the year after they have given birth. Those mental health problems can come in many different forms—from eating disorders, to post-traumatic stress disorder, to anxiety and depression. If left untreated, the mental illnesses that these women experience can affect their whole lives, their ability to cope with being a parent and their relationships within and outside their families. The illnesses can affect attachment and bonding with the baby. At their extreme, perinatal mental health problems can lead to suicide and to long-term health problems for a child.

[Lyn Brown (West Ham) (Lab)]

I understand that one fifth of parents stated that they were not asked about their mental or physical health during the six-week post-natal check-up. Does my hon. Friend think that might be because GPs are massively overburdened and simply do not have the time to deal with this essential issue?

[Dr Williams]

I thank my hon. Friend for raising that point. I will refer to it later in my speech. I think the pressure on GP services that she has identified is one reason, but there are some other reasons to do with training and perhaps resources.

--- Later in debate ---

[Dr Williams]

I thank my hon. Friend for making several points, including that a child whose mum experiences mental health problems is more likely to develop mental health problems themselves. Despite significant Government investment in specialist perinatal mental health services, significant inequalities remain throughout the country and there are still areas where, as he said, one quarter of women with significant mental health problems are not able to access specialist facilities. I hope we will get the chance to talk more later about access to specialist services.

Other adverse childhood experiences include domestic violence; parental separation or divorce; being a victim of physical, sexual or emotional abuse; physical or emotional neglect; or growing up in a household where there are adults experiencing alcohol and drug problems. Mental health problems in a mother can have as significant an impact on a child as some of those other problems. The term ACEs was originally developed in the US, but other studies have reported similar findings in England and Wales. Those ACEs have, as my hon. Friend has said, been found to have lifelong impacts on health and behaviour. They are relevant to all sectors and involve all of society.

An ACE survey of adults in Wales found that, compared with people who had experienced no ACEs, those with four or more were more likely to have been in prison; develop heart disease; frequently visit their GP; develop type 2 diabetes; have committed violence in the last 12 months; and have health-harming behaviours, such as high-risk drinking, smoking or drug use

Children’s exposure to adverse and stressful experiences can have a long-lasting impact on their ability to think and to interact with others, and on their learning. Health and societal inequalities that develop during early years stick with children for life. That is why I chair the APPG for the prevention of adverse childhood experiences. It is also why the identification and treatment of maternal mental health problems is not only important for the individual mother but crucial for all of us in society.

National Childbirth Trust research shows that as many as half of new mothers’ mental health problems are not picked up by a health professional. That is not to say that health professionals are not asking—they often are. There are many fantastic nurses, GPs, midwives, health visitors and others who provide care during pregnancy and during the post-natal period. However, those services, as my hon. Friend the Member for West Ham (Lyn Brown) has said, are overstretched. We all know how hard-pressed GP services are. The Government have acknowledged the problem and have promised to recruit an extra 5,000 GPs by 2020. However, they are failing miserably and are struggling to even maintain GP numbers. NHS Digital reports a decrease in full-time equivalent GPs from March 2017 to March 2018.

Perhaps a little less well known is the dramatic fall in the number of health visitors. Since 2015, there has been a loss of more than 2,000—almost a 20% drop—so each health visitor has to work harder. I commend health visitors for the work they do but, overall, women are experiencing a drop in services.

Staff numbers are part of the problem, but there are many other reasons why the problems of almost half of women with perinatal mental health problems are not identified. Stigma, and the societal pressure to be seen to be coping, makes it hard for some women to disclose that they have a mental health problem. Also, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) has said, health services do not always ask women about their mental health in the most sensitive way. That is sometimes because they are pushed for time and sometimes because they have not been trained to sensitively and gently probe behind the “I’m okay” response that people are primed to give.

As a result, the hidden half of new mums with mental health problems struggle on alone, often afraid to reach out for help. The overwhelming majority of women who experienced a mental health problem said that it had an impact on their ability to cope or look after their children, and also on their family relationships. The mother of a woman suffering from post-natal depression told me:

“As a parent, watching a child go through that and feeling unable to make it better is a horrible experience. Health professionals need to make sure that husbands, partners and the family know about the likelihood of such depression…and know where to get support and help.”

Perinatal mental illness has an immediate effect not only on mothers; it can have lasting consequences for relationships in the wider family. With the added pressure to be a perfect mother, and the expectations from many that come along with that, it is no wonder that so many women feel unable to cope. One constituent described this to me:

“I remember comparing myself to the younger mums who would turn up to the mother and baby groups looking fresh and without a care in the world, making motherhood look like a walk in the park. Although my son was thriving, I felt like I was failing, because I wasn’t like the young mums or the ones in those perfect baby ads. I didn’t want to share my feelings because I felt I’d been a failure in comparison to them. I believe the pressures of our professions and the guilt of parenthood traps us into a dark place.”

It is often the most vulnerable who receive the least support, with evidence suggesting that those in areas of higher deprivation are less likely to be asked about their mental health. In dealing with this issue, the Minister has the chance to fulfil two parts of her ministerial brief, because investing in perinatal mental health will help to improve mental health and reduce health inequalities.

I have described the problem, but what are the solutions? Identification is key. Regardless of what services may or may not be out there—from specialist mother and baby units, to secondary care perinatal mental health teams, to cognitive behavioural therapy and the prescription of medication—half of women with the problem are not even identified. That is where I believe we need to start.

The disinvestment in health visiting is significant; there can be no solution to the problem while health visiting is not properly resourced. Will the Minister say what she intends to do within her Department to ensure that local authorities are adequately funded and supported so that there is investment in crucial services for children aged 0 to 19, rather than the cuts that we have seen in the past three years?

However, there is another, relatively low-cost opportunity to identify the hidden half. About six weeks after giving birth, new mothers see their GP for a six-week baby check, with many practices also offering a maternal health check. Official National Institute for Health and Care Excellence guidance encourages doctors to do that and inquire about a mother’s emotional wellbeing, providing an opportunity for them to spot the development of any mental health problems. That check could be the last time a mother sees a health professional for a routine appointment in which there is the opportunity to focus on the mother, rather than her baby.

While some women get an excellent six-week check, showing its potential, other women miss out. A fifth of women questioned in a recent NCT survey said that they were not asked about their emotional or mental wellbeing at that appointment. Some women’s checks are all about their baby. Why do all women not get the check that they need? Despite the six-week baby check being part of the GP contract, for which they receive funding, doctors do not receive any funding for the check on the mum. It is a credit to many practices that they offer the checks without funding, but making the time for a full appointment can be challenging, meaning that there is little opportunity to encourage a mother to talk about how she feels, which takes time. A rushed appointment can make many, like the constituent of the hon. Member for Thirsk and Malton, feeling dismissed, or like it was a tick-box exercise.

One woman I heard from recently said her appointment made her

“feel like she was a burden”.

Another of my constituents spoke movingly of her experience:

“I knew there was something very wrong almost as soon as my son was born. Nothing I was ‘supposed’ to be feeling was happening. All I wanted to do was cry. I was feeding him and taking good care of him, but I felt empty inside, and so sad. I can’t remember anyone asking me how I was. I only saw my health visitor once, and that wasn’t in private so there was no opportunity to confide in her.

I told my GP I had postnatal depression and that I needed some help. He told me ‘you have a good family, you should be grateful—you need to pull yourself together.’ I don’t think I have the words to explain how damaging that was. I felt too ashamed to see him again so I changed to another medical centre. My first appointment was with a GP who listened to me. I found the courage to confide in her and she offered me support straight away. I remember very little of my child’s first year of life and I’m sure that is because of the trauma and deep depression I experienced.”

That could have been prevented if my constituent had been seen early on in the post-natal period, and if that first GP had delivered open, supportive questioning that reassured her, rather than made her feel ashamed.

Another constituent told me:

“I sat down with my GP, who had a check-list printed out and placed on his desk. He ran through the questions at a rapid rate, didn’t listen to my answers at all and placed ticks in the boxes after he asked the questions—not based on my reply. Hopefully a separate check for mothers can be achieved, as mothers just want someone to talk to who will not judge them for their feelings.”

About 30% of women diagnosed with post-natal depression still have depression beyond the first year of childbirth. If problems are not identified and treated early, they can worsen and develop into a much more severe mental illness. That underlines the need for an early check. If depression was recognised and treated appropriately within the perinatal period, it could prevent some effects that are much harder to treat in the long run.

[Lyn Brown]

I am sorry to intervene again. I intended to make a speech, but I am needed elsewhere, so I will ask a question. I have a lot of time for the Minister and I am wondering how we can help her to make the necessary case to the Treasury. Is it not true that if we look after the parent and the child as early and as well as possible, that will save massive amounts of money in the long term? This is an invest-to-save opportunity, and it would be welcome if the Government took it.

[Dr Williams]

I thank my hon. Friend for her intervention. I have avoided, as much as I can, talking about money in the debate—not all of this is about money, but there are many opportunities to make a massive difference. If we can draw a direct link between a mum’s experiencing mental health problems and the damage that that may do to her child—it increases the child’s chance of developing health problems and even of being involved in crime later in life—there are certainly opportunities to invest to save.

We must not forget, either, that perinatal mental illness has serious consequences for the mother. Suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy in the UK. It is at least possible that if an effective six-week check were in place, some of those deaths would be prevented. Of course, this is, as many hon. Members have said, a complex issue. Diagnosis and treatment are complex, but in addition some health services undoubtedly do not give women the care that they need. Women feel that they are still being dismissed, stigmatised and ignored. However, we should not blame the individual GPs and health professionals who carry out the checks; we should look to change the guidance, the system and the structure in place.

From its research, the NCT has made three recommendations. The first is to fund the six-week maternal post-natal check so that GP surgeries have the time and resources to give every new mother a full appointment for the maternal check. At the moment, although the check focusing on the baby is contracted for and there is funding available for it, there is no requirement for a six-week check on mothers. Checks on mothers, if they are done, are often compressed into the baby’s check, so conversations about mental health may be rushed or sidelined completely.

A constituent got in touch after I said that I was going to speak in this debate. Her response was surprising. She said:

“After the birth of my first child, I suffered terribly with post-natal anxiety—something I didn’t even know was a thing. I don’t remember anyone ever picking up on how I was feeling and no one ever really asked.

Then after the birth of my second child I believe I was depressed. When he was born I didn’t feel anything which then made me feel guilty”—

a common theme—

“and I struggled to bond with him over the first year.”

She then said:

“I believe I met you”—

meaning me, because I was working as a GP in the constituency at the time—

“at my six-week check with him and I remember you asking how I was feeling. After telling you I think I may have needed to”

get some extra help

“for more therapy, you agreed it was a good idea and told me to come back”

for follow-up. She continued:

“I think women need to know where they can go for help and what signs to look out for. I was too scared to tell anyone that I didn’t feel any bond with my son because I think there’s still such a stigma around mental ill health.

I do think the idea of a separate appointment for the mother would be a good idea and more signposting to support groups, how to self-refer, confidential information and advice.”

That experience with my patient, who is now my constituent, demonstrates the value of making time to identify and explore perinatal mental health issues. It might be argued that GPs should be doing that anyway, even if it is not contracted for. I would respond by saying that some are and some are not. GPs do many things that are not in their contract. But the only way of getting true national coverage and the time needed to do a proper job is to resource it.

Oral Answers to Questions

Baroness Brown of Silvertown Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

I am grateful to the hon. Lady for raising some of the issues at the Pennine trust. We are well aware that it needs improvement, which is why we have buddied it up with the outstanding Salford Royal NHS Foundation Trust next door. The Salford trust is led by Sir David Dalton and the Secretary of State referred to it earlier. I will take up the matter raised by the hon. Lady directly with Sir David.

[Lyn Brown (West Ham) (Lab)]

7. What steps his Department is taking to work with community pharmacies to reduce (a) waste and (b) the cost of medicines.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

NHS England has a range of initiatives for waste and medicine cost reduction. We estimate that there is a prize of up £150 million a year to be realised across the system on waste. Community pharmacies have a significant role to play in that, partly through their existing duty to review prescriptions when repeat dispensing and partly through the separately commissioned medicine use reviews.

[Lyn Brown]

The Minister is absolutely right to say that community pharmacies have an important role to play. On 17 October, he told the House:

“We do not believe that any community pharmacies will necessarily close as a result of these cuts.”—[Official Report, 17 October 2016; Vol. 615, c. 597.]

However, the impact assessment published by his Department just two days later described a possible scenario in which 1,000 pharmacies close. Will the Minister confirm that nobody in Britain will have to travel further to get to a chemist as a result of his cuts?

[David Mowat]

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

Young People’s Mental Health

Baroness Brown of Silvertown Excerpts

Thursday 27th October 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. I warmly congratulate, too, the clearly very talented Youth Select Committee on producing such an excellent report, which cogently highlights the need for additional and better mental health services for young people. It is a job very well done indeed.

For too long, those suffering from mental ill health have received far less care and attention than those suffering from physical ailments. Even though mental ill health accounts for 28% of the total burden of disease, it gets just 13% of the NHS budget. One in four adults is diagnosed with a mental illness at some point in their lives, but only about a quarter of those who need mental health services have access to them. Serious medical conditions are going untreated because of the disparity of esteem between physical and mental health that everybody—the Government, health professionals, patients, the voluntary sector—speaks of wishing to end. There is such a long way to go.

The consequences of our neglect of mental health services are devastating. Over a third of people with mild mental health problems and almost two thirds of those with more severe mental health problems are, in fact, unemployed—yet research shows that the vast majority of them wish to work.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I thank my hon. Friend for giving way and congratulate the Select Committee on this report. She makes an important point about the number of people with mental health issues who are unemployed. I have been struck by the message from schools; one in my constituency told me that it was referring 40% of its pupils for mental health support. Does she agree that early intervention, as highlighted in the report, is vital? Does she recognise the work of Members of the Youth Parliament, including Tafumi Omisore in Hounslow, who raised these important issues with us?

[Lyn Brown]

Absolutely. I totally agree with my hon. Friend, and as I go through my speech I am hoping to provide an example to show how intervention is particularly important for a very young child because of the impact on the rest of the family. Early intervention can do a lot to mitigate other events and difficulties occurring in the family that might include other family members, too.

Unfortunately, tragically and outrageously, young people’s mental health services often receive less attention than adult mental health services, so that young people’s mental health services have been called the “Cinderella of Cinderella services”. In November 2014, the Health Committee found that there were

“serious and deeply ingrained problems with the commissioning and provision of services for young people’s mental health.”

Many providers reported increased waiting times and increased referral thresholds for specialist services, where patients would have to show severer symptoms to receive treatment than they would have done in the past. GPs reported feeling ill-equipped and lacking in confidence when dealing with young people’s mental health issues. The Select Committee found that early intervention programmes were

“suffering from insecure or short term funding, or being cut altogether.”

There really is no excuse for this failing. Around half of people with lifetime mental health problems experience symptoms by the age of 14, and about 75% of them before the age of 18. Catching these problems early could well lessen the severity of adult problems, possibly saving the NHS money in the long term. More importantly, I would suggest, it would reduce unnecessary suffering and enable people to live better lives.

I want to be fair to the Government, who have recognised that there is a problem. In 2014 they set up a children and young people’s mental health and wellbeing taskforce, which made a number of recommendations in its 2015 “Future in mind” report. The taskforce identified a number of problems with young people’s mental health services. The right hon. Member for North Norfolk (Norman Lamb), who was then the responsible Minister, said that there needed to be a fundamental shift in culture, with a much greater focus on prevention and early intervention.

The taskforce rightly recognised that one of the challenges facing young people’s mental health services was—unsurprisingly—funding. I was pleased when the Government responded by announcing the provision of an additional £1.4 billion of transitional funding for youth mental health services, but that additional money needs to be considered in the context of the less encouraging overall picture of mental health services funding. NHS England’s planning guidance states that all clinical commissioning groups must increase their spending on mental health services by at least as much as their overall budget increases. However, there have been warnings from organisations including mental health trusts that mental health funding is not properly ring-fenced, and that NHS England’s target is being missed.

Let me again follow in the footsteps of my hon. Friend the Member for Dulwich and West Norwood. We know from the responses to a series of freedom of information requests from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) that more than 50% of CCGs intend to spend a smaller proportion of their budgets on mental health in 2016-17. That clearly demonstrates that what the Government tried to do has failed, and that that target is being missed as well.

[Mike Wood (Dudley South) (Con)]

The hon. Lady is making some important points. She referred to the taskforce’s “Future in mind” report. According to one of its startling statistics, only between 25% and 35% of young people with diagnosable mental health conditions access support. Does that not underline the need for much better training and much more awareness among both teachers and GPs, in respect of early identification as well as early intervention?

[Lyn Brown]

We need early identification and we need early intervention, but we also need the funds to ensure that there are services to which people can be referred. That is the rub of this whole debate. There does not seem to be the necessary funding at any point in the journey of young people who need help, whether in the form of awareness, intervention or services.

I have been looking into the good work done in my borough, the London borough of Newham. Even in these difficult times, it is increasing its mental health spending in both absolute and relative terms, and its children’s mental health services received an “outstanding” rating from the Care Quality Commission. I wanted to find out how we could improve young people’s mental health provision, and to learn about the challenges that an “outstanding” local provider continued to face in its fight for better services. Professionals in Newham recognise that a good young people’s mental health service does not just help those who have already developed severe and serious conditions, but provides early intervention and preventive programmes so that problems can be dealt with at source.

[Seema Malhotra]

Is it not important for young people’s mental health services to consider the needs of parents as well? I was struck by a recent case in which the parents did not understand where the issues had come from and could not identify what they were, and felt unable to understand how best to help their child.

[Lyn Brown]

My hon. Friend is right. The family is often key to the provision of the support that a young person needs, but a family may itself need intervention to gain the support that it needs to lead a mentally healthy life.

The national lottery funded a programme in Newham called HeadStart, which helps 10 to 16-year-olds, particularly in schools. It trains teachers in secondary schools to develop programmes that help to build resilience among their pupils. It also provides children directly with mentoring schemes so that they can learn from each other about how to manage mental health issues—it is peer-to-peer learning—and works directly with parents to show them how they can work through mental health issues with their children. Unfortunately, the scheme relies on lottery money rather than core funding, which means that its future as a core service cannot be guaranteed. It is often difficult to obtain the necessary proof that would persuade funders—including the Government—that core funding should continue, because the timescale is often not big enough to be persuasive.

Newham would love to run more services directly in the community, and more integrated services, because it knows that they make a real difference to people’s lives. M, aged two, and her baby brother T, just seven weeks old, were referred by a perinatal psychiatrist, who was helping their mother to deal with chronic mental ill health. M was still frequently breastfed, and showed a very insecure attachment to her mum. Her anxious, and therefore sometimes controlling, behaviour was making it difficult for her mum to wean her and to attend to the needs of the new baby, who was being bottle-fed. M’s speech was also delayed.

Following assessment, the family were offered parent-infant psychotherapy, which enabled them to reflect on the needs of both children, and gradually to help M to become more independent of her mum. At the same time, T was able to have more appropriate attention from his mum as the baby of the family. I am pleased to say that, following that intervention, M is more confident and her speech is developing. She sleeps in her own room, and has settled well into nursery. That is an example of our physical and mental health services working in tandem to improve real lives.

J was a 17-year-old who had been arrested and charged with possession of a weapon and affray. He had a history of violence and non-engagement with services. During the course of his referral to a youth offending team, the team became concerned about his mental health, and referred him directly to a child and adolescent mental health services specialist for an urgent examination. During that assessment, J was having suicidal thoughts, was highly anxious, and showed quite severe symptoms of obsessive-compulsive disorder as well as softer symptoms of attention deficit hyperactivity disorder.

The youth offending team nurse arranged for J to have urgent psychiatric treatment. He was put on medication for his anxiety, with an accompanying course of cognitive behavioural therapy for his obsessive-compulsive disorder. He will also be assessed for ADHD in the longer term once his more acute symptoms abate. I am pleased to report that J has not offended since he has engaged with the mental health services offered through the youth offenders team. That shows that integrated services are better for individuals, and better for the whole community.

Those are just a few of the stories that I have been told, but I believe that there are enormous challenges to the provision of community-based and fully integrated services. I am told that Newham would love to run services directly from general practices, but they cannot currently do so because they do not have the necessary resources. With the current staffing levels it would not be efficient, because staff would spend as much time travelling to and from general practices as they would spend helping patients.

Health professionals acknowledge that early intervention work often increases rather than reduces workload in the short term. Professionals in Newham worry that they simply will not be able to deliver the clinical hours that are necessary to help more patients. Over 50% of patients in Newham already have to wait for more than five weeks to see a specialist, and that figure can only increase when further cases are uncovered without corresponding additional resources.

Some well integrated and community-based mental health services are delivered in Newham and, I am sure, throughout the country, but if we want to preserve and expand those programmes, we must be aware that they need stable and long-term funding. A good place to start would be ensuring that money designed for mental health services actually finds its way to the front line.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my hon. Friend the Member for South Cambridgeshire (Heidi Allen) for initiating this debate on the Youth Parliament Select Committee report on young people’s mental health. I want to add my voice to those from both sides of the House in paying tribute to the Youth Select Committee for its powerful report—it is an important and timely intervention. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, Rhys Hart was, by all accounts, a remarkably effective Chair, and the 10 members were dedicated and focused. They won the admiration of the House of Commons staff who were involved, and they made particular mention of that to me before this debate.

The hon. Member for Ilford North (Wes Streeting) demonstrated quite clearly that he is an elected president of the BYC, with his particularly eloquent speech. He is right that we should thank those young people who have had the courage to speak up on their mental health experiences and opinions, and who have allowed us to refer to them today, because the value of those first-hand stories in this Chamber cannot be overestimated.

I would like to make a particular point of thanking the constituents of my hon. Friend the Member for High Peak (Andrew Bingham), Lucy Boardman and Martha Banks Thompson, and my own Youth Parliament representatives, Tara Paxton-Doggett and Rowan Ibbotson, who spoke to me about the mental health campaign. A number of colleagues have spoken about the impact of meeting the Youth Parliament representatives. As has been said today, what is important now is to prove that we have not just heard them; we have listened to them, and we are taking action on their words. That is why this has been such a moving and necessary debate.

Members have shared some very personal experiences of mental health and the services and support that they and their constituents have received. All of us will know the cases that haunt us. All of us know that we need to do better. As colleagues have said, over half of all mental ill health starts before the age of 14, and 75% has developed by 18. We know the distress that mental health problems cause to individuals and all those who care for them, and we know that the earlier we intervene, the better.

Children’s and young people’s mental health is a priority for this Government. Not only has the Health Secretary made it his personal priority, but so has the Prime Minister. It is time for a step change in the way that we deliver mental health services in the UK, and we are determined to deliver that. But we must not underestimate or under-sell some of the progress that has already been made, because that is thanks largely to the efforts of dedicated NHS staff, stakeholders, voluntary services and others. We have heard some success stories today, and it is important that we praise those involved for the hard work that they do in the face of great challenges.

We agree with recommendation 3 that funding needs to increase, as many colleagues have said. That is why we have increased investment in children’s mental health, with an additional £l.4 billion. While we do believe that it is right that local CCGs, led by clinicians, are best placed to prioritise their spending to meet the needs of local populations, we have been clear that this money is provided for mental health services, and we are requiring CCGs to increase their spending year on year.

[Lyn Brown]

Has the Minister considered the request from my local mental health providers that the Government consider ring-fencing the money for mental health so that it gets passed to the frontline?

[Nicola Blackwood]

I was attempting to deal with that point, but obviously not being very clear. As I said, we have been listening to these requests. We are looking very closely at how effectively the money is getting to the frontline, but at the moment we still believe that local clinicians are best placed to decide how to target these services. However, we have put in place a requirement for CCGs to increase spending on mental health year on year. We are also very clear that STPs must reflect the NHS mandate, which says:

“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole”.

That will require great strides to be made in improving care.

[Lyn Brown]

This is happening in Newham, but not elsewhere. How long is the Minister going to wait for it to happen elsewhere before taking action?

[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

National Arthritis Week

Baroness Brown of Silvertown Excerpts

Thursday 20th October 2016 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate, and for his excellent contribution. I also thank the charities, such as Arthritis Research UK, that work every day to reduce the suffering brought about by joint disorders.

Last week was National Arthritis Week. The pain of arthritis is often invisible. Trying to explain its constant, chaotic pain to someone who has not lived with it can be very hard. A survey conducted by Arthritis Research UK found that 28% of women with arthritis feel that people do not really understand the pain they face. Despite trying to talk about it, they feel lonely with the disease. That is why today’s debate is so important. By talking about arthritis in this place, we can begin to tell people that they are not alone.

I want to do that in a literal sense, by sharing my experiences of arthritis. In March 2015, we were two months away from a general election, which, as Members on both sides of the House know, is a difficult, stressful and busy time to be a politician. As part of the shadow ministerial team, I was driving up and down the country with my tiny dog Cara in tow, visiting fire stations and sharing Labour’s plans for the future of the fire service. It should have been an exciting spring, sharing a vision that I was passionate about, and introducing my little four-legged friend to a bunch of soppy but very brave firefighters. However, it was made difficult as I had been experiencing mobility problems for quite a while, and it was not unusual for me to be in constant pain and experiencing stiffness. However, until that point I had been able to fight through. I had not considered that I had a condition.

In March, I finally hit a brick wall. I felt completely and utterly drained of energy and could barely walk more than a few steps. I had to drag myself up the stairs of my house by pulling on the bannister. I was unable to stand at street stalls for any length of time, or go canvassing. I contacted voters only on the phone, or at meetings where I could be completely sedentary. I needed help putting on my bra. I felt humiliated, embarrassed and a complete and utter failure. At the worst, I was struggling to stay awake for more than six hours a day. It can be imagined what that did to my mental health. The stress of not being able to fight that election on my own terms was overwhelming. The tiredness and pain were looked after by a specialist, but throughout that period I had no idea whatever of what the problem was. At times like that, the internet is not a best friend. My imagination was in overdrive. Only the support of good friends, comrades, my wonderful husband and my family got me through that election.

Let me be clear. I do not want to come across as some kind of stoic hero. I am not. I cried, mainly in my doctor’s surgery as I was trying to get some answers. The staff must have thought I was completely wet. I found it really difficult to cope with the condition and the demands of work at that time. I know that many people have that feeling, and it is little wonder that musculoskeletal conditions account for one in five working days lost to ill health in the UK.

Despite being referred to my arthritis service in November 2014, it was early May 2015 before I was finally diagnosed with seronegative inflammatory arthritis. I now know that fatigue is very common among sufferers of arthritis due to pain, stress and sleep disturbance. More specifically—this is not very well known out there—fatigue is a symptom of inflammatory arthritis. Chemicals called cytokines are found in the inflamed tissues and cause extreme fatigue.

At that point I was put on a course of methotrexate, which thankfully caused the aggressive nature of the condition to begin to recede, but it was still quite aggressive, and I needed additional medication to get me to where I am now, taking methotrexate and injecting myself every fortnight with CIMZIA, a biological injectable medicine. The pain and restrictive movement have now subsided considerably. A number of colleagues have told me as I walk around the House that I seem to be doing much better, and I am.

When I first met my arthritis specialist, she asked me what my goals were. I said I wanted to be able to walk Cara again, to wear heels and to play tennis, which would be some feat as I have never played tennis before. She laughed and said, “Let’s keep this realistic and start with walking the dog.” I am happy to say that with the support of the NHS I can now walk Cara for over an hour, almost entirely pain-free. At Christmas last year, I bought a pair of blue polka dot shoes as an incentive and a symbol of hope. I have worn them twice and, although they are not as high as those of the Prime Minister, or indeed our former shadow Chief Whip, my right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), they are a symbol of the progress I am making. What is more, I have just enrolled on a course of tennis lessons, which I will start in March next year, two years after I hit that dreaded wall.

I have had good treatment, advice and support, and I thank my doctors for that from the bottom of my heart. Ten million people in the UK suffer the pain of arthritis and not all are as lucky as I have been. Moreover, I am told that with an ageing population and rising physical inactivity, the number of people living with arthritis will rise. We must make sure that every patient has access to excellent treatment. Due to the high cost of the drugs and the guidelines of the National Institute for Health and Care Excellence, most patients have to wait at least a year before they can access the transformative biologics that have made such a huge difference to my life. I had to wait just over a year, and that year was hard.

The wait means that we are not controlling the condition at an early stage or enabling patients to stay active, independent and in employment. Surely this wait is not cost-effective to industry and the economy. I know that this is ultimately an issue for NICE, but making these drugs more widely available will transform arthritis care for many, as it has done for me. Let us be honest: there are problems with traditional treatments. Although methotrexate has been really important for me, it can have long-term negative effects on the liver, but coming off it is certainly not an option for me at the moment. I urge the Government to support research on the long-term effects of existing drugs, and to continue to support vital research into new treatments and life-saving drugs, so that we can help people to live pain-free into old age.

I will be positive: there have been substantial breakthroughs in arthritis treatment as a result of research funded by Arthritis Research UK. They include treatment for rheumatoid and inflammatory arthritis, and treatment to prevent miscarriages in women suffering from antiphospholipid syndrome, which again is something I have. If only I had known a couple of decades earlier.

World-leading scientists, working in British institutions, such as Leeds, Birmingham and Keele Universities, the Kennedy Institute at Oxford, and St Mary's hospital, London, developed these treatments. The biological treatments I am on have been developed here in the UK. We should be so proud of these achievements, but we must make sure that our medical research sector remains at the cutting edge. Now more than ever, the UK’s excellence in medical research is under threat. Many of us warned before the EU referendum that funding for medical research would be hit if we voted to leave. Vicky Forster, a researcher, wrote in The Guardian:

“many scientific disciplines will lose EU funding post-Brexit”.

That is certainly the case with arthritis.

Figures provided by Arthritis Research UK show that between 2011 and 2015 the EU contributed over £2.5 million to its projects. Those researchers have gone on to secure more than £18 million of European funding to support the next stage of their work. It should be a priority for the Government to maintain our world-leading medical research sector. To do this, they need to ensure that overall investment in UK science and research is protected and grown in the longer term.

The risk to research posed by Brexit does not stop at funding. Sir Paul Nurse, director of the Francis Crick Institute, said:

“Science thrives on the permeability of ideas and people and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.”

Leaving the European Union threatens this melting pot of ideas. In 2014-15, Arthritis Research UK committed more than £30 million to research that was hosted in the UK, but had collaborators in 13 European Union countries. If the Government want to make sure that our medical research sector remains as vibrant and as successful as it is, it is important to maintain the current ease with which those involved in medical research are able to travel and work across the EU and the UK.

We should be truly ambitious as a country and aim to expand arthritis research and medical research more generally, not merely preserve what we have. I have been told that structures need to be in place to encourage our NHS clinicians to participate in research. At the moment, this is not possible due to the demands on the NHS and a medical culture that puts research second.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I commend my hon. Friend on making this excellent debate so moving. She shows how important this issue is. She is a living, breathing example of why research is so necessary. She looks 10 years younger than she did last year.

[Lyn Brown]

rose—

[Mr Betts in the Chair]

I say to the hon. Lady that four other hon. Members want to speak, and there are only 20 minutes left.

--- Later in debate ---

[Lyn Brown]

In conclusion, Mr Betts, I hope that sharing my experience today has helped to play a small part in letting people who live with arthritis know that they are not alone. I was lucky to have good treatment. I can now walk Cara, wear heels and look forward to playing tennis. I want the Government to make sure that the UK remains a world leader in medical research, so that we continue to find ground-breaking treatments and more of the 10 million people living with arthritis can live their lives relatively pain-free.

[Several hon. Members rose—]

Defending Public Services

Baroness Brown of Silvertown Excerpts

Monday 23rd May 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Each year, the Government put before Parliament their expenditure programme, the Budget, and their legislative programme, the Queen’s Speech. These two moments in the parliamentary calendar are meant to encapsulate what the Government are all about, what they will do and how the country will change. Ministers like to make grand claims on the merits of their programmes, and it is our duty to detach the cheerleading and scrutinise the reality of what is being said.

The scrutiny of the March Budget saw the Government’s triumphalist claims fall apart under the weight of reality. Debt forecasts are up, growth is down, and public services are continuing to be chipped away, with inner-city constituencies such as mine hit the hardest. We saw little ambition to enable the fifth largest economy in the world to work for ordinary people, or any ambition truly to invest in our futures.

Two months on from the Budget, the new legislative programme is now before us. It comes with more triumphalist claims about life chances, but in reality those claims mask a Government coming apart at the seams. We know the Prime Minister’s eye is on Europe, and his potential successors are sizing up his job. It is a Tory Game of Thrones. The White Walkers are out to get him, but before we feel sorry for this beleaguered Prime Minister struggling to keep Britain in the EU, let us remember that it is his weakness before his party and his MPs that has brought us to the brink of an exit from Europe—an exit that would be disastrous for our country.

Let us look at the Queen’s Speech. It is possible that not everything in it will be bad. It is possible that the lifetime savings Bill is a positive development, but we cannot be sure without seeing the detail. There is a lot more that is not good for Britain and will exacerbate the public service crisis. Above all, there is a glaring gap, which is a lack of purpose and a lack of direction. The programme does not even attempt to tackle the country’s many challenges, which include: a growing housing crisis with a need for many more social, intermediate and affordable homes; an ageing population and health inequalities; a skills deficit and productivity gap that contribute to chronic low growth; and an air pollution crisis in our capital and, as I understand it, elsewhere.

Ministers claim that the programme is about life chances and a one nation approach, but let us look at what is happening. There is a growing gap in life chances across the country. The Government’s own Social Mobility and Child Poverty Commission says:

“There is a gulf between today’s divided Britain and the ‘one nation’ the Prime Minister desires to lead.”

The commission says there is

“a growing social divide by income and by class.”

Wealth inequality has risen for the first time in almost a decade, says that deeply socialist paper, the Financial Times. The Institute for Fiscal Studies says two thirds of children in poverty live in working households, up from just over half in five years. The number of children living in absolute poverty, after housing costs, has risen by 500,000. Public services are under ever more pressure, and things are getting markedly worse than they were in 2010.

NHS waiting times in England are longer, with more than 3.5 million people on waiting lists. A&E has seen the worst performance figures on record, with patients waiting longer to be seen. There are also longer waiting times to see a GP. Cuts to older people’s care have seen delayed discharges from hospitals reaching a record high. Cuts to nurse training places have led to staff shortages, and also created a massive financial hole as agency staff have had to be hired to cover the vacancies.

There are fewer police and fewer firefighters. Social services are under strain, and social worker vacancies are on the rise. Sure Start centres have closed. Teachers and doctors are leaving the professions. Museums and libraries have been decimated, leaving children and families without basic educational resources to supplement their schooling. House building is at its lowest since the 1920s, and homelessness in London has leapt 80% since 2010. These are not just figures, but personal stories of anguish. We are seeing a real impact on lives, on jobs, and, ultimately, on life chances. That is the real story of Britain under Conservative rule.

I must praise the valiant efforts of councils, especially Labour councils, to try to keep things running. They are innovating, but with the financial squeeze—a 25% cut in budget during the last Parliament and an 8% cut set for this one—and the policies of this Government, it is becoming ever more difficult to do so. That is the rub: the Government have the wrong priorities. Who supports what is happening in the NHS—the unnecessary reorganisation and the attack on junior doctors? It is certainly not the patients or NHS staff. The NHS is a prized national asset and provider of collective health security. The Government’s approach is more about the prejudices of the former Health Secretary and the bunker mentality of his successor. I am glad that there has been some backing down, but it is simply not enough.

Who supports the Government’s plans for the BBC? Looking at my postbag, it does not seem to be the licence fee payers, the actors or the programme makers. What benefit is it to Britain to run down the BBC, a prized national asset with a global reputation? The action seems to be more about the prejudices of the Secretary of State for Culture, Media and Sport. There has been a backing down, but it is not enough.

Who supports the forced academisation of all schools? It is not the teachers, the parents, the pupils, or even the Tory councils. What does it solve to force good schools to concentrate on unnecessary reorganisation? It is more about prejudices relating to state schools. There is little consideration of the real issues of falling school budgets, chronic teacher shortages, not enough good school places and children being left to fall behind. There has been another backing down on academisation, but why the need for so many U-turns, and why is the Bill even in the Queen’s speech? Those are just some examples of the wrong priorities; there are many more.

A long time ago, the Prime Minister said:

“We will trust the professionals.”

How little we hear of that now. The Government’s approach is riven with contradictions. The devolution agenda offers a real opportunity for improved services. I am talking about the opportunity to bring services together in localities and to use new technologies and ways of delivery. We also have new leadership. I am delighted that Sadiq Khan was elected Mayor in London and Marvin Rees in Bristol. There is a real opportunity there, but devolution is going hand in hand with a raft of Government cuts. It is the political interference that is having a lasting effect. The Government are driving the destruction of the sense of public value, public service, and public assets and the principles of collaboration and excellence. I plead with Ministers and Government Members to be a little more honest. The right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), freed from the shackles of Cabinet responsibility, admitted when he resigned that there is a lack of fairness and compassion. He said that the disabled will be impacted by the Government’s policies, which have been

“enacted in order to meet the fiscal self-imposed restraints that I believe are more and more perceived as distinctly political rather than in the national economic interest.”

This Queen’s Speech is not about the challenges that are facing Britain. It is not an honest conversation about how public services can be improved and reshaped to meet the needs of all of us in the 21st century. Sadly, it is a missed opportunity from a Prime Minister who is running out of time to prove that he can leave a positive legacy for our public services and indeed for our country.

Junior Doctors’ Contracts

Baroness Brown of Silvertown Excerpts

Wednesday 28th October 2015 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Countless junior doctors have been in touch with me to say that they are worried and in despair about the Government’s threat to impose an unfair contract on them. They tell me that the dangerously long hours that the contract will introduce will be a threat to patient safety. Doctors tell me that rostered hours are not a realistic gauge of total working hours, and that reducing them will not prevent dangerous increases in working time.

Sofia, an anaesthetist in my constituency, says:

“A ‘normal’ rostered day starts at 7.45am and finishes at 5.45pm. In reality there is no such thing as a ‘normal’ day, because the clock strikes 5.45pm and it is impossible to walk out the door with an operation ongoing.”

Doctors like Sofia are content to work longer hours out of a sense of duty, but they are deeply concerned by plans to remove the financial penalties placed on hospitals to prevent dangerously long hours. She describes the Health Secretary’s assurances as follows:

“It’s a bit like trying to stop speeding on a busy road by lowering the speed limit, but at the same time getting rid of all the speed cameras, police and speeding fines.”

What does all this mean for patient safety? I was contacted by another doctor, Keir, a paediatrician in a neonatal intensive care unit in West Ham. He cannot see how his team could be spread more thinly during the week in order to provide more doctors on Saturdays. He is rightly concerned that doctors would be at risk of exhaustion. He says:

“High intensity specialties are particularly affected from a safety point of view. You don’t want any delay putting a three-month premature baby on life support. Putting in a breathing tube, getting a tiny line into tiny veins—all require skill and concentration. Any tiredness affects the swiftness and accuracy of these procedures.”

Doctors like Keir are aghast at what the Government are telling them.

Doctors are also deeply disheartened by the Government’s handling of the new contracts. One doctor, Simi, has told me:

“The mood is grim in hospital at the moment. We feel under-appreciated and undervalued. We are not being misled by the BMA. We can read the facts and analyse them for ourselves.”

Whatever the Health Secretary has said today, it is evident that some doctors will lose out financially. This uncertainty over pay is causing anxiety. Sofia says:

“Come August 2016, I have no idea how much I will be paid, whether I will be able to afford to pay my bills or even spend time with my children.”

I agree with Oliver, another West Ham doctor, who says:

“Not one doctor should be taking home less pay than they do now.”

This will have serious consequences for staff retention. Doctors are making plans to leave the NHS. Nick, a medical student in West Ham, says:

“I studied medicine to become not just a doctor but an NHS doctor. Under the proposed contract, I’ll be left in the sad situation of being forced elsewhere.”

That will be this Health Secretary’s legacy. Kirsty, a histopathologist, says:

“The health secretary has been nothing but belittling and demeaning. He has suggested we have lost our sense of vocation. Imposing a contract on us and treating us like children rather than professionals is so wearing.”

We trust these doctors with our lives and with our loved ones. Our NHS staff are truly phenomenal. They deserve nothing but the utmost respect, and they certainly do not deserve to have an unfair, unjust contract imposed upon them. The people in this country love the NHS. For their sake, the Government must put forward fair proposals, withdraw the threat of contract imposition and return to negotiations with the BMA.

Health

Baroness Brown of Silvertown Excerpts

Monday 9th June 2014 Commons Chamber

[Priti Patel (Witham) (Con)]

It is a pleasure to speak in the debate because it is a Queen’s Speech that will help to deliver a stronger economy for this country and better and stronger public services. Four years ago, this Government embarked on a radical and necessary programme of measures to turn the fortunes of this country and our economy around. For 13 years, my constituents were betrayed and let down by the previous Government, as taxes rose while unemployment soared, the economy went into meltdown and public services wasted taxpayers’ money on a colossal scale.

It is a tribute to this Government’s economic focus and policies that we have been able to turn things around. Ministers have implemented many clear measures. For example, unemployment in my constituency is now almost half the level it was when it peaked under the previous Government in 2009. These are the positive policies that I bring to today’s debate on the NHS. It is a testament to this Government’s commitment to the NHS that we are now seeing an increase in spending.

I heard the opening speeches in the debate, including by Labour Members. It is appalling that the Labour party likes to talk as though it owns the NHS politically. That is wrong. Labour should listen to some of the facts not just in my constituency but in the eastern region. The fact is that Labour went into the last general election with plans to cut NHS spending—we have heard about the impact of that in Wales—while we have continued to invest in the NHS. While Conservatives recognise the increasing pressures that the country faces from demographics and the health care needs of the public—

[Lyn Brown (West Ham) (Lab)]

Will the hon. Lady give way?

[Priti Patel]

I want to develop my discussion and go into more detail on the NHS. More investment in the NHS is required. This is not about cutting services, including front-line services, or funds. It is about expanding the NHS in the right way and, as the Secretary of State said, putting patients first and moving away from the bureaucratisation of the NHS.

[Lyn Brown]

Will the hon. Lady give way?

[Priti Patel]

Let me continue.

There were classic examples of that not just in my constituency but more widely in Essex. We heard earlier about Basildon hospital. In my constituency, one primary care trust saw its number of managers and senior managers increase tenfold over a decade. At the same time, it failed miserably to recognise the health needs of my constituents; we have a growing population as well as an ageing population. I had cases in 2010 where patients were denied access to life-saving hospital treatment and access to drugs because the PCT sought to prioritise spending on the bureaucracy of the NHS, rather than front-line patient care.

In Witham town, at the heart of my constituency, there is a chronic shortage of locally accessible health care facilities. All the talk by Labour and the slogans referring to “record investment” under Labour translated into nothing in my constituency. Under the previous PCT and the previous regime, we had consultation after consultation but no new services were created.

[Lyn Brown]

Will the hon. Lady give way?

--- Later in debate ---

[Gordon Birtwistle (Burnley) (LD)]

The health service is very close to everyone’s hearts, and there are a lot of political gains to be made from it. I have to say that, as the Member of Parliament for Burnley, my election chances were boosted when Labour’s Secretary of State closed down our A and E unit. I am delighted to say that the coalition Government have now delivered us a brand new emergency centre in Burnley, which shows that the coalition Government have delivered good things, especially for the people of Burnley.

There is one issue that I really want to talk about today. I have been a councillor for 31 years—I stood for election only last month and increased my majority over Labour in my ward—and the issue that has become very close to my heart is the care of elderly people. I am talking about elderly people who are on their own. People from companies call on them in the morning to get them out of bed. They stay for 10 minutes to make sure they are up and have had some breakfast. They then come back at lunchtime to make sure they have eaten some lunch, and then again in the afternoon to make sure they have had their tea. They come back in the evening. As one elderly man said to me, “They come back at 8 o’clock and tell me to get ready for bed.” He said, “I don’t want to go to bed at 8 o’clock in the evening. I am 87 years old. I fought for this country, and now they are telling me that I have to go to bed at 8 o’clock. I don’t want to do that.” What he wants is for someone to come and see him in the morning and talk to him. He is housebound, and he does not have a family. He is not the only one in that situation. There are many more like him in Burnley.

We are a poor town and people cannot afford to pay for private services. These people want to talk to somebody in the morning when they get up; they want a bit of conversation. They do not want staff running in with their meals-on-wheels food in a foil container saying, “We’ll come back and see you later.” They want to talk to someone. They want to know that there is somebody who cares for them; somebody who is interested in listening to them. This elderly man has some fantastic stories about his life; I have seen him many times. When the staff come back in the evening, he is not asking them to stay all night. He is asking them to show a little bit of interest in him, and he certainly does not want to go to bed at 8 o’clock at night. He has never gone to bed at that time and for someone to tell him that he has to do so, “or he’ll be on his own” is wrong. I am not being political here. All I am saying is that we should care more for the elderly people of this country. I am talking not about people who are in their 60s, but about people who are in their 80s and 90s who, unfortunately, have been left on their own. They might be elderly ladies whose husbands have died. These are people who have worked for this country all their lives and fought for this country, and are now, certainly in my constituency anyway, being left alone. I find that hard to accept. I might be unusual. There might be people who think it is tough and bad luck, but I do not think that. We should be looking after these people and showing them some compassion. We are a wealthy country. Apparently, we are the fourth or fifth wealthiest country in the world, and the contribution that these people have made over their lives has helped to put us in that position.

Burnley is an industrial town; we had the pits and the mills. Now we have high-tech industry where young people work and create wealth. Fortunately these days, they are able to put something aside for their pension, which will help to look after them in their old age. The elderly people from the ‘70s, ‘80s and ‘90s could not do that; they were on poor salaries. In the main, the wives did not work. My mother never worked. My father brought up our family, and my mother never worked. All right, my mother and father are dead, but there are still people around who were in the same position. Many have lost a partner and in the main their children are out of the area, and they need us to care for them. Is it a lot to ask for someone to turn up and say, “Hello, Mr Jones. How are you?”

[Lyn Brown]

The whole House is listening very quietly to what the hon. Gentleman is saying because it resonates. My father is 87. He pays for carers to come in from an agency. What has upset us is the fact that his life savings are paying the wages of people who drive Lamborghinis, who employ people on the minimum wage and who provide very poor care to the people the hon. Gentleman is talking about. This Government need to act to ensure that the care offered to our people, which they pay for out of their meagre savings, is of the quality that they deserve.

--- Later in debate ---

[Lyn Brown (West Ham) (Lab)]

It is wonderful to follow the hon. Member for Totnes (Dr Wollaston), and I totally and utterly agree with her concluding remarks.

Some may say that the absence of any reference to health legislation in the Queen’s Speech is a blessing; after all, the unwanted top-down reorganisation foisted on the NHS by the coalition and the previous Secretary of State is said by many to have put such a strain and stress on the NHS that it has been brought to its knees. Many Members present will know from their casework, inboxes, surgeries and personal experience that there is a rising tide of public concern about the NHS because of the lack of accountability and because decisions are being made upstream from local services. Our constituents may well view the absence of any mention of health in the Queen’s Speech as evidence of complacency, disinterest and unconcern. I have to say that I would agree with them. The Government have taken away the local means to secure improvements in services, and in this Queen’s Speech they have missed an opportunity to bring back local focus and accountability.

I want to look first at GP provision. One of my constituents wrote to me in April out of “sheer despair” at her inability to get an appointment at her surgery for an issue that she has said is not urgent. She has a busy job, is at work at the times she needs to call the surgery, and cannot leave work at the drop of a hat should she be offered an on-the-day appointment. As she put it,

“the current system is an absolute joke, to put it mildly…this current NHS system is completely useless”.

My constituent needs and deserves Labour’s GP access guarantee. Is there anything like that in the Queen’s Speech? The short answer is, “No, there is not, but there should have been.”

My constituents do not have the same access to GPs as people in other areas. Building on NHS England’s most recent survey, the Royal College of General Practitioners shows that 16.82% of patients in Newham were not able to get a GP appointment when needed, compared with 5.36% in Bath and North East Somerset. The Government should adopt the GP access guarantee to address those inequalities, and the Queen’s Speech would have been the right place to introduce such proposals.

Before its abolition, Newham primary care trust had a clear plan to tackle and improve the challenging local situation, of which I was an active and enthusiastic supporter. Today, I am far less sure that mechanisms are in place locally that have the capacity and motivation to root out poor practice and promote the best. My misgivings were confirmed when I asked who now decides what to do when, for example, there is a vacancy at a GP practice in Newham. The answer came back—I still find this astounding—that the decision rests with NHS England. What is more, I was told that the London office of NHS England has a small number of people who deal with the provision of GPs, dentists, opticians and pharmacists. They must struggle to keep up with the paperwork, let alone have any capacity to look at proactive work on quality, improvement and service development.

What local knowledge can NHS England have about what is happening on the ground in Newham? How can that make any sense, and how is NHS England accountable to Newham’s people and its clinicians? What does it say about the reality of this Government’s commitment to localism? It is surely a matter of great regret that the Secretary of State did not seek to use this Queen’s Speech to address some of those very real issues.

In his response, the Secretary of State will no doubt include fine rhetoric about control being in the hands of GPs locally through the clinical commissioning group. He will laud to the skies their skills, commitment to patients and the NHS, and their virtue in all respects. I have talked at length to my CCG in Newham and worked closely with it, and I assure the Secretary of State that I share his opinion of its estimable qualities. In fact, I would add more approving words to his glowing testimony. I also know, however, of the CCG’s absolute frustration at the straitjacket that the new NHS structure requires it to wear, and I share its recognition that the reality of local empowerment is very different from that described by the Secretary of State and enforced with the diktats of NHS England.

The new structures leave decisions in the hands of NHS England. Surely the current Secretary of State can see that that is nonsense. In his calm, perhaps even reflective moments, I think that he knows and would admit that, if only to himself. What a shame that he did not use the Queen’s Speech to intervene and turn his rhetoric of localism into more local control over NHS decisions.

--- Later in debate ---

[Mr Andy Slaughter (Hammersmith) (Lab)]

I am sorry that this debate began with a speech that was smug and complacent even by the standards of the Secretary of State for Health. I thought we had reached a low point until I heard the hon. Member for Thurrock (Jackie Doyle-Price) using a speech on the NHS to promote the tobacco industry. I am glad that those speeches have been balanced by those we have just heard from my hon. Friends the Members for Walsall South (Valerie Vaz) and for Westminster North (Ms Buck). Indeed, the speech from the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), reaffirms Labour’s commitment to the health service, which is fairly lacking from this Government.

I am going to speak about the crisis in the west London health service, partly because it is such a major crisis and partly because I think it indicates the way the Tories are dealing with the health service generally. It began two years ago, almost exactly, with the announcement of the biggest hospital closure programme in the history of the NHS. Since then we have had sham consultations with 100,000 people petitioning and being ignored, U-turns, confusion, incompetence, refusal to answer questions and political chicanery to make what happened in Ilford, as we heard from my hon. Friend the Member for Ilford South (Mike Gapes), look like a model of probity. Now we have the contamination of the whole NHS locally, including the primary care sector.

When the closure programme began, the medical director of North West London NHS said, candidly, that if it did not close four A and Es and two major hospitals, it would literally run out of money and go bankrupt. Those are the words he used. I suppose we should be grateful to him, because those statements galvanised the population of west London to engage in “save our hospitals” campaigns, and they have been campaigning for two years in rain and snow. Despite huge disinformation paid for by the taxpayer, by a Conservative council and indeed by the NHS, when I now stand in Lyric square in Hammersmith on a Saturday, I can be sure that 99% of my constituents know what is actually happening. I pay tribute to those campaigners from all political parties—including a lot of ex-Tories, as well people from minor parties, Labour supporters and others. They have really made the running on this issue.

Yes, there were changes. Initially, for example, we were going to lose the whole of Charing Cross hospital. Now there will be a local hospital on the site. When that was first mooted, a senior member of the local Conservatives and a Cabinet member said:

“This is an enormous teaching hospital with a 200-year history. You can’t make the Charing Cross hospital into a local hospital. It’s absurd. People won’t put up with that.”

Within weeks, they were spending ratepayers’ and taxpayers’ money putting out leaflets saying that Charing Cross hospital had been saved. That was compounded last October when the Secretary of State for Health stood here and effectively said, “Oh, it won’t just be an urgent care centre. It’ll be a second-tier emergency department.” Let me clarify the three differences between those two: recovery beds, X-rays and GPs. I thought we had GPs on duty in urgent care centres, but apparently not; we can just have nursing cover. It is an urgent care centre by any other name; to call it an A and E is misleading. It will lead to people with serious medical conditions going there and risking their and their family’s lives—as we have already seen at Chase Farm and elsewhere. Charing Cross and Hammersmith will not have blue-light emergencies—except for heart attacks in the case of Hammersmith. We will not have a stroke unit; we will not have the 500 emergency beds; we will not have intensive treatment. This is a second-class, second-tier health service.

The worst transgression happened in only the past few weeks during the local election campaign. I am not making this up, Madam Deputy Speaker. After the postal votes were opened and the Hammersmith Conservatives saw that we were ahead in some of their safe wards, the Prime Minister was brought down at short notice and locked in the basement of the Conservative party offices with a local journalist and came out with this pronouncement:

“Charing Cross will retain its A&E and services”.

I believe that the Prime Minister is an honourable man, and that he was misled into making that statement. The statement is demonstrably false because the NHS has clearly said that most of those services—other than treatment services, primary care services and elective surgery—will not exist at Charing Cross hospital under any analysis.

I thus went to see Imperial. It was the day after the election and I had been up for 30 hours and was not in a terribly good mood. I went to see the new chief executive of Imperial, and I tried to persuade her that Charing Cross should stay open. I said that I would take the new Labour leader of Hammersmith council to see her, as he might be able to persuade her better than I could. I then left and went home. That evening, she e-mailed to say, “Oh, I forgot to tell you when you were here: we are closing the other A and E in your constituency on 10 September. It was just a short meeting and I did not have time to tell you about it.”

At the same time, as my hon. Friend the Member for Westminster North said, the CCG is writing to tell us that it is good news that in year—in the middle of a financial year—it has decided to pull together £140 million from the CCGs around north-west London and to redistribute it into primary care. In other words, they are panicking and having to take desperate measures because the primary care services are so short of money and cannot pick up the slack from the closure of A and E services. We might think, “At least they are doing something”. A substantial proportion—they will not say how much—is going out of my CCG and into other CCGs because, they believe, that is a fair way to distribute money. We are losing not only both A and Es, but our primary care funding and, with the closure of Hammersmith A and E—if we cannot prevent it from going ahead in September—Imperial has admitted in its own board papers that there is insufficient capacity at St Mary’s hospital.

[Lyn Brown]

Has my hon. Friend conducted any analysis that could reveal whether the redistribution of funds among the CCGs will take money from the more deprived areas and give it to those that are better off?

[Mr Slaughter]

I thank my hon. Friend for that intervention. In exactly the same way, the Government are choosing to close the A and E department at Hammersmith hospital, which is slap bang in the middle of one of the most deprived areas of London, covering White City, Old Oak, Harlesden, north Kensington and east Acton. That means that 22,000 people who rely on those A and E services every year will have to travel to St Mary’s hospital in Paddington. They will not be directed to Central Middlesex hospital, which will be closing on the same day, and they will not be directed to Charing Cross hospital, because the plan is to close that within a year or two. They will be told to go to St Mary’s, where there are not enough beds and not enough capacity in A and E to cope with the current demand. That is contrary to undertakings given in the House that there would be no closures of A and E services until alternative services were provided. There will also not be enough acute services to provide a training base for students at Imperial college.

Two weeks ago we won the election in Hammersmith, against the expectations of, at least, the Conservatives, and we won it on this issue. If the Government will not listen to the 100,000 people who petitioned, perhaps they will listen to the people of west London who, on the issue of the NHS, overwhelmingly voted Labour and against the policies that are being pursued by the Conservatives. They should listen, and they should think again about hospital closures that will cost the health and the lives of my constituents.

Cervical Cancer Screening

Baroness Brown of Silvertown Excerpts

Thursday 1st May 2014 Commons Chamber

[Alison McGovern (Wirral South) (Lab)]

It is an honour to contribute to this important debate, and I welcome to the House of Commons today Sophie’s mum, Peri, her sisters Chelsea and Ashleigh, and other members of her family. I have been very proud to be involved in this campaign to highlight what happened to Sophie, who was my constituent. I think I am right in saying that this has been the biggest ever e-petition, which I think represents a real change in the way we do our politics in this country. Long gone are the days when only certain people in this place could call on us to hold debates here and only the Government said what we would talk about. In Sophie’s name, her very many friends and family have brought us here to talk about these issues today. That is a massively important change in our politics, alongside the important issue we are discussing.

I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram)—even though he keeps saying that I am the hon. Member for Wirral West, which I am not; I’ll have a row with him about that later—on having initiated this extremely important debate. As I have said before, it is very important for men in Britain, as well as women, to care about women’s cancers, and I will say more about that and about awareness. I make a plea, however, for all my male colleagues, as dads, brothers and friends of women as much as anything else, to ensure that they know the symptoms of cervical cancer and other women’s cancers, and to support their sisters, friends and mums if they have any concerns. That is important.

I begin my contribution by borrowing the words of Peri, Sophie’s mum, which she has allowed me to do. She characterised what Sophie was like in a really brilliant way:

“She was an amazing daughter, sister, girlfriend and friend, a live wire with a huge heart, the glue that held our family together. Her attitude to life was to live it to the best and her positivity shone through to everyone so as you couldn’t help but smile”.

I think those are lovely words about Sophie, and it is in her name that we all come here today. I know I represent all my constituents when I offer their condolences to Sophie’s friends and family, and I feel sure that the many thousands of people who signed the e-petition did so because they wanted to show that they cared about what happened to her. Members might be interested to know that friends and family have also organised fundraising events—they did so before Sophie died—and are taking care of all her family. That is a truly great thing.

Sophie had high aspirations for her life, and she had hopes and plans. She was clearly a vibrant, clever, beautiful young woman with her whole life ahead of her. She attended her GP surgery as she had been suffering for months with symptoms such as stomach pains and various things, and it seems that her request for a smear test was refused on the basis of her age. My hon. Friend the Member for Liverpool, Walton has gone through those issues in some detail. It seems that Sophie was diagnosed with Crohn’s disease, but her health continued to deteriorate until she was eventually diagnosed with cervical cancer and very tragically died in March, just 19 years old.

The disease is rare in younger women, but in this case a smear test would have been important. Sadly, this is not the first case to come to light in which a young woman has died of cervical cancer following such events. Mercedes Curnow died aged 23 in 2011, and reports suggest that she too had requested a smear test. Another young woman, Becky Ryder, was 26. Thankfully, such cases are few and far between, and we are grateful for that; none the less we will all understand the tragic scenario that friends and family face when a young woman faces such a serious disease. Even though the numbers are relatively small, it is important that we take the issue seriously.

Approximately 3,000 cases of cervical cancer are diagnosed in the United Kingdom every year. While there are groups of people such as women under 25 among whom cervical cancer is rare, it does occur. I understand that there are approximately 2.5 cases of cervical cancer for every 100,000 women under 25 years old. It is thankfully rare, but very serious for those people who face it. How can we help GPs to pick up the symptoms of something so rare? A balance has to be struck, but it is important to raise GPs’ awareness of such conditions—rare though they are, they do happen.

There are potential risks in screening women under 25, which have been mentioned. The consequences of unnecessary screening can cause problems in later life, which is why the medical community has had such a discussion about the point at which screening should be done. As politicians, our first regard must be for the medical evidence, and we would never ride roughshod over that, but one thing that we have perhaps not always got right is making information available to people and accepting that people should be trusted with that information. The NHS is very good at giving advice and telling people what they should be doing, but much less good at giving information to help people to make their own informed decisions. The e-petition is about choice and how we ensure that people have the information they need to make the choice for themselves. I understand that Dr Moss of the Advisory Committee on Cervical screening has argued that volunteering to have the test should be an option. If someone does make that request and is turned away, it could cause a very negative response when they are invited for the test later. I know that Sophie was one of the youngest victims of this devastating disease, and such requests would be rare, but people should have the choice.

The debate is an opportunity to talk about the importance of smear tests. We have all had the invitation and thought, “Oh goodness, I’m not really sure I want to go for that.” But it is vitally important that people have the test if invited, and I hope this debate will make people think about the importance of having a smear test. Cervical cancer is a real problem, and the hon. Member for Basildon and Billericay (Mr Baron) rightly talked about early diagnosis and said that that was a problem across various types of cancer. The biggest challenge we face in fighting cancer is getting people to come forward early, and my view is that that is more of a problem in areas of social deprivation. I know from Merseyside, my home patch, that in such areas people are likely to have busy lives, perhaps less awareness, and a bit less confidence and are perhaps working shifts. They may be concerned about symptoms but put their concerns aside, for whatever reason, and the possibility of diagnosis gets later and later.

We need to recognise the differential prevalence of late diagnosis in different areas, and we should ask what we can do to recognise and address the various social and economic factors that can cause late diagnosis.

[Lyn Brown (West Ham) (Lab)]

I am listening to my hon. Friend’s speech with interest and she anticipates many of the points that I want to make. Does she agree that women often put themselves last, behind their family, and there are always other pressing issues to be dealt with rather than a routine cervical smear? Somehow we have to get it across that the smear test is as important as anything else they have to do.

[Alison McGovern]

In my slightly cack-handed way, that is what I was trying to say. Women are incredibly good at putting off things that concern our own health, which is why it is important that our brothers, fathers, husbands and friends encourage us to be concerned about our health and to look after ourselves. It is also important that we make the point today about the importance of smear tests. People should have a choice and be able to talk to their GP about having a test if they need one, and if invited to be screened, they should take up the invitation.

--- Later in debate ---

[Lyn Brown (West Ham) (Lab)]

Let me begin by offering my condolences to Sophie’s family, and thanking the Backbench Business Committee for scheduling the debate.

As we have heard, cervical cancer, although rare in women under 25, can be far more aggressive than cancers developed by older women. As we saw in the tragic case of Sophie’s death, her cancer had a devastating effect although she was only 19. The smear test that Sophie requested would have shown abnormal tissue growth in her cervix, and, although it might have been too late to save her life, the fact that she was refused that test is tragic. We must all learn the lessons of her death, and seek new and better ways of dealing with such cases.

Newham has a lower incidence of cancer than many other areas, but, sadly, our mortality rate is higher, owing mainly to late presentation. In 2012 the London-wide mortality rate was about 112 deaths per 100,000 cases, while in Newham it was 123 deaths per 100,000 cases. There have been instances in which stage 4 cancer has presented itself for the first time in A and E departments, and we know that there is no stage 5.

As we heard from my hon. Friend the Member for Wirral South (Alison McGovern), there is a relationship between deprivation and death from cancer. Social and economic deprivation have a severe impact on health, as has been shown by countless reports and studies. The figures for London and England clearly demonstrate that deprivation contributes to the incidence and types of cervical cancer, and to the survival rates of sufferers. The mortality rate among those in the 30 most deprived areas is nearly double that among those in the 30 most affluent.

Although the deprivation in Newham means that poor health is more prevalent there than it is in other areas, excellent work has been done in the borough, especially in our schools. Newham is also building on its current 90% coverage of the human papillomavirus vaccination programme. It is one of only two areas to have achieved that target, thus helping to prevent cancer despite the barriers to screening uptake. However, as we know, HPV immunisation does not entirely eliminate the risk of cervical cancer. That should be explained clearly to young women who take part in the programme, which is what is being done in Newham.

Regular smear testing is the only way in which individuals can be sure that their health needs are being met. In the case of cervical cancer, the take-up of screening services in Newham was just 22% in 2012-13. That is nearly 2% less than the figure for the previous year, and below the average figures for London and England, which, sadly, are only marginally better. Poor survival rates in deprived areas are arguably due to low take-up of screening, which results in the cancer presenting itself at a later and more advanced stage.

I am pleased that the Government have said that they aim to match European survival rates and, in doing so, save approximately 5,000 more lives, but it worries me that no indication has yet been given of how that will be measured, or, indeed, whether the targets are being met. Cancer networks, which were established in 2000, are currently being replaced by strategic clinical networks, which will deal not only with cancer but with maternity, mental health and dementia. Many professionals have suggested to me that, given that the new networks will cover a wider clinical range and a larger geographic area and will retain fewer dedicated cancer network staff, the overall decrease in funding may well lead to an inconsistent and unreliable service. I think that the Government should heed those fears and examine the allocation of resources to ensure that the areas with the greatest need receive appropriate funding, thus reducing the disparities in life expectancy and survival between the least deprived and the best off.

There is ample evidence of the need for awareness of conditions such as cervical cancer to be kept at a high level, and that requires continual effort. Following the death of Jade Goody in March 2009, 70% more women than the normal average were given smear tests, and I must admit to being one of them. I am sure that I am not the only woman in the Chamber today who has found other things to do rather than nipping down to the doctor for that very quick, clear test. Most of those who were tested were aged between 25 and 39, which is the age group with the lowest rates of attendance for screening. That is understandable, given that smear tests can be very uncomfortable and even painful in some instances, but we still need to have them.

Owing to the nature of the populations of Newham and, I assume, similar areas, national awareness campaigns struggle to have a fully effective impact in our communities. We need to understand why that is, and take action to deal with it. I am grateful to Newham’s fantastic Community Links charity, whose awareness campaigns have been very proactive. It has been instrumental in driving up screening rates, and its work in schools has ensured that its message reaches not only children throughout the borough, but their families at home. Children are a great way of getting to parents, and nagging them to pieces.

I know that the aim of this debate is to ensure that other girls, unlike Sophie Jones, can have their concerns heard. Much more needs to be done to educate young women about the detectable symptoms of cervical cancer, and it is imperative for the NHS to remove as many of the barriers to screening as possible. I urge the Minister to look at the excellent work of Community Links, and to consider whether the action that it has taken on behalf of my community can be learnt from and prove relevant in other parts of the country.

--- Later in debate ---

[Jane Ellison]

As I said, the hon. Gentleman presented quite a detailed statistical submission and I shall respond to him after the debate rather than off the cuff. His statistics deserve better than that.

Cervical cancer is thankfully very rare in women aged under 25. As has been said, there were 47 cases in England in 2011, the last year for which we have figures. That is less than 2% of all cases and there were two deaths. Obviously, we will consider the statistics presented by the hon. Member for Cheltenham (Martin Horwood), but we are aware that in 2009-10—this also relates to the points made by other hon. Members, and most strongly by the hon. Member for West Ham (Lyn Brown), about health inequalities—an extra 600,000 women came forward for screening, many as a result of the publicity surrounding the death of Jade Goody. Many of those women were from lower socio-economic and hard-to-reach groups, and they are more often at risk. That is an important statistic and we need to consider that again.

It may help the House if I briefly run through the science behind the abnormal screening results in younger women. Primarily, they are caused by the fact that they have a high rate of HPV infection, as the cervix in young women is more prone to infection with transient HPV, both because it has not yet matured and because younger women might be exposed more often to different types of HPV. Furthermore, some of the few cancers found in young women are unusual and rare tumours that differ from the type we screen for, such as small cell tumours that can develop rapidly and are very dangerous. However, some are HPV-associated tumours that develop at a young age and sometimes simply as a rapidly developing cancer. The key thing in such cases is rapid referral and an appropriate medical response.

In its 2009 report, the ACCS was concerned that young women presenting to primary care with symptoms of cervical cancer were not always given the best advice. I know that that will be a concern not only to Sophie’s family but to all of us in this House and to the NHS. We know that for many GPs, seeing a patient with cervical cancer is rare, and potentially only one GP in 16 will see a new case each year. That is quite a statistic. To help GPs make the right clinical decisions, new guidance for primary care on the management of young women with gynaecological symptoms was developed and sent to all GPs in England in March 2010. The guidance was developed by a multi-disciplinary group, and supported by all the relevant royal colleges. I undertake to raise the issue again with the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners to explore the best way to remind GPs of the guidance.

I reiterate that whatever her age, if a woman is concerned about abnormal symptoms she should contact her GP, who will be able to examine and refer her urgently to a gynaecologist if clinically appropriate. The House might not be aware that the guidance is explicit that in any case where a woman is showing symptoms, best practice is that she should not be referred for screening. That is because a cervical screening test is aimed at women without symptoms. It is a screening, not a diagnostic test, and waiting two weeks for the result could delay examination by a gynaecologist. That is a really important point to bring out in the debate. If someone has symptoms, we want to get them urgently from symptom to diagnosis via a referral, and a screening test could further delay that.

I want to talk a little, as others have, about the human papilloma virus, or HPV. Many Members have mentioned the fact that we have identified high-risk types of the virus and that the vaccination programme sprang from that identification of risk. The programme was introduced in 2008 for girls aged 12 to 13. Its aim was to prevent cervical cancer related to the HPV types covered by the vaccine, which covers about 70% of all cervical cancers. The programme has been a big success. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage in the world, with 86% of girls eligible for routine vaccination in England in the 2012-13 academic year completing the three-dose course, and 90% receiving at least two doses.

It may be of interest to Members to hear that the Merseyside area team reports a higher than national average take-up of the HPV vaccine, with 87.8% of girls vaccinated with all three doses in 2012-13. In Wirral and Sefton, that figure was 90%. However, we cannot be complacent and we want to get the fullest possible coverage. That is something about which MPs, as well as Ministers, can do a lot to spread the word. When we go into schools, a good question to ask might concern the coverage and whether there are particular groups of parents or people from particular backgrounds who do not take up the vaccine.

It is expected that the programme will eventually save more than 400 lives a year from cervical cancer. The first indication that the programme is successfully preventing infection with HPV types 16 and 18 in sexually active young women in England was published in the scientific journal Vaccine, and showed that the proportion of infected rates in 16 to 18-year-olds fell from 17.6% in 2008 to 6.6% between 2010 and 2012. That is major progress, so the take-up of the vaccine is really important.

We encourage all girls, irrespective of religion or ethnic background, to receive the HPV vaccination. NHS England is responsible for making arrangements to implement the programme for eligible girls and young women in the local area, taking into account local circumstances, such as the number of independent or special schools and the number of girls who are not in school. Interestingly, I was informed that Surrey has a much lower take-up, so perhaps we need to consider how to deal with girls in independent schools, or other local circumstances. NHS England is also responsible for ensuring that local programmes meet the national specifications.

We are using our growing knowledge of HPV to modernise the NHS’s cervical screening programme by considering HPV infection alongside the screening programme and looking for abnormalities and seeing how they can interact. Public Health England is also promoting the use of the HPV test as a primary screen, which is very interesting. A lot of work is going on, and the first evaluation report of the pilot is due in spring 2015. Cancer Research UK has estimated that, when fully implemented, HPV primary screening could prevent hundreds of cancers a year.

There are some particular matters to which I would like to draw the attention of the House, as I have a little time. The Prime Minister’s £50 million GP access fund will support more than 1,400 practices covering every region to offer extra services for those who struggle to find appointments that fit in with family and work. That is important and responds to one of the points made by the shadow Minister.

I hope we can show that despite tragic cases such as Sophie’s, the age at which screening starts in England is based on sound evidence. It has been carefully considered by members of expert committees pretty recently. However, I am very aware that we need to keep all evidence under review. I have already had a brief conversation with the chief medical officer about this. Members may be aware that one of my fellow Ministers is a specialist in this area of medicine, so we will make sure that we look again at the points that have been made in the debate.

There is much we can do as a House and as a country to reduce the number of women who suffer from this devastating disease. I urge every woman invited to screening to take up the opportunity, as we know that 25% of women in the 25-to-30 age group do not. On screening, I do not have time to describe the work in detail, but I can assure Members that Public Health England has work under way specifically to look at low coverage in certain areas and to work on local action plans to improve that coverage.

I want to do more to urge employers to support their staff. Again, evidence from Jo’s Cervical Cancer Trust, representatives of which I met on Monday evening and discussed some of these issues with, suggests that many younger women do not want to ask an employer for time off for a smear test. I will look at what we can do through work that is already going on with employers to see how we can encourage them to make it clear to young women that they do not have to go through an embarrassing conversation to get time off for that. I will be looking at that further with Jo’s Cervical Cancer Trust.

If Members who called the debate and spoke in it have the appetite for it, I am happy to devote a special day in Parliament to what we can do on take-up of screening and of HPV vaccination. I would love to do that piece of work with hon. Members if they want to work with me on that, because much of this is down to local and specific community factors. A one-size-fits-all national programme is not adequate. As part of Be Clear on Cancer, we have a pilot programme on ovarian cancer which will be running this spring, so we are moving into those gynaecological issues. We will look at the review of that to see whether there is more we can do in this area. Work is under way, but there is so much more we can do working together.

[Lyn Brown]

I am grateful to the Minister and I will certainly take her up on that. May I remind her of the hysteroscopy campaign, which we could perhaps dovetail into that work?

[Jane Ellison]

Of course. I remember that I responded to the hon. Lady on the detail of that.

I have started to write routinely to the chairmen of health and wellbeing boards to make them aware of issues that are of interest to parliamentarians and changes in law or guidance. I undertake to mention this subject, particularly in the context of Sophie Jones’s case, in my next letter to health and wellbeing board chairmen, to draw it to their attention. There is a 1 million study under way by the National Institute for Health Research under its health technology assessment programme to look at the issues of effective interventions for younger women on the take-up of screening, so work is in progress.

Oral Answers to Questions

Baroness Brown of Silvertown Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

I know that my right hon. Friend showed great interest in this issue when he was in my Department. When I say that the strategy is here to stay, I mean that it is here to be refreshed and updated. We are subscribing to some big new ambitions, including that by the time of the next election two thirds of people with dementia will be diagnosed and have a proper care plan and support for them and their families. That is a big improvement on the 39% of people who were diagnosed when we came to office. There is much work to do, but I assure him that we are absolutely committed to delivering.

[Lyn Brown (West Ham) (Lab)]

Some hospitals are making a virtue out of quick discharge for their stroke victims. Is the Secretary of State convinced that elderly stroke victims, perhaps those without people to advocate on their behalf, are getting appropriate care and that their care and rehabilitation are not being scrimped on or rationed?

[Mr Hunt]

No, I am not convinced. We need to do much better when it comes to the discharge of vulnerable older people, especially when they leave hospital not cured and still with a long-term condition. They may be recovering from a stroke or dementia or any other condition. We need to have much better links between hospitals and GPs and to have named accountable GPs in the communities looking after those very people.