Prisons (Substance Testing) Bill

Debate between Lyn Brown and Bob Stewart

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

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

I am grateful to you for calling me, Madam Deputy Speaker—I love Fridays.

I congratulate the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) on bringing forward her Bill. I know that she will have done so because she wants to make a real difference for the most vulnerable in society, just as she did with her Autism Act 2009. This Bill has Labour support. I am looking forward to serving with the right hon. Lady on the Bill Committee, and I hope that the Government will ensure that the Bill has a smooth passage today and through all its parliamentary stages.

As the hon. Member for North West Durham (Mr Holden) rightly said, substance misuse is an extremely important issue for our criminal justice system, our prisons and our communities. Sadly, this week, drug-related deaths hit an all-time high. Drug dependence and abuse is a massive factor in many people’s offending and, indeed, reoffending. This year, the Black review found that about a third of prisoners are in prison for reasons connected to drug use. Of that third, 40% are actually in prison for drugs offences, so 60% are there for other crimes, such as theft or robbery, which they often commit to pay for the devastating financial cost of an addiction.

As we know, the cost of an addiction is not just financial. Many psychoactive drugs, including novel psychoactive substances—I will call them NPS so that I do not have to say those words throughout my speech—such as Spice, can take a terrible toll on physical and mental health. In prison, as in the outside world, many people take drugs to escape the bewildering, scary or miserable circumstances of their lives. Unfortunately, the substances taken to experience fleeting moments of distraction or numbness make the problems of chaotic lives so much worse.

Drug misuse, just like alcoholism, is a medical problem, and healing it requires well funded, long-term, holistic medical and social intervention. We know that substance abuse treatment works to reduce reoffending. Analysis by the Ministry of Justice suggests that being in treatment cuts reoffending by 44%, and that the number of repeat offences committed is cut by about 33%. It is likely that if treatment were better funded, larger reductions would result.

Over the last 10 years, responsibility for drug treatment has been transferred to councils, and the ring-fenced budget has been removed and reduced. Local government grants and public health funding were both cut. Many of those who are in our prisons today might not have been there if they had got help earlier—if society and the state had had the resources to step in and stop a downward spiral before it started—but to quote the American President, we are where we are. Now, we have to do everything in our power with those who are in prison to ensure that the conditions are there for good health, effective treatment, decent living conditions and a seamless transition to treatment in the community upon release. Without those things, I do not believe that somebody who has done wrong and is in prison will get a second chance to turn their life around.

The interventions made in individual prisons, and the policy for prisons across England and Wales a whole, can be made more effective if prison governors and the Prison Service have knowledge of what is happening with drugs inside. This Bill is intended to help with just that, and Labour Members support that essential purpose, just as we supported by Psychoactive Substances Act 2016—I should know, because I was the shadow Minister on that Bill. During its passage I learned lots. In particular, I learned that Spice and other new and initially unregulated psychoactive substances can have a devastating effect on people, and that their use in prison has had some terrible impacts on prison safety and stability.

Spice use can cause prisoners to behave extremely unpredictably and in ways that are out of character, and it has led to violent attacks on prison staff and on other prisoners. That primarily affects prison officers and workers. Like the hon. Member for North West Durham, I have been told by the POA that its people have been faced with the utter horror of someone they have known for a long time—perhaps a young man who has been in the revolving door and been in and out of prison without ever being a problem—taking Spice and being turned into “an utter lunatic who wants to kill you and who feels no pain.”

When a batch of Spice manages to get into a prison and is distributed widely across the population there can be a wave of problems, with people physically collapsing, having a mental health crisis or becoming violent. It is clearly in the interests of vulnerable prisoners, staff and our communities for the system to be able to respond more quickly to changing recipes, new symptoms, new routes in and new users, which is why this Bill is so welcome.

May I gently point out, however, that there is evidence to suggest that a disproportionate number of Spice users may not be in treatment? The Forward Trust has estimated that between 60% and 90% of the prison population have used an NPS at some point, yet in 2018-19 only 11% of prisoners in treatment had NPS use noted as one of their problems, so there is a huge disparity there. Most prisoners on a treatment programme went into it immediately upon entering prison. I know we will agree that picking up on the substance abuse immediately is an important thing, but it does not account for those who start misusing a drug while in custody. Such people may have had no other history of this. So I would be grateful to hear a little from the Government—or they can write to me—about what they are doing to improve treatment provision, alongside getting the more accurate testing that we need and that this Bill provides for. Public Health England estimates that every £1 spent on drug treatment has a fourfold return, and that has to be worth looking into.

I am told that when somebody uses Spice it is obvious, so there is a bit of a concern that the powers in this Bill will be used for the purposes of punishment, rather than for making an effective order of treatment. It would be a great pity if that is all that happens as a result of this Bill, with prisoners subject to greater punishment rather than getting treatment, because then it will not improve rehabilitation, and it will not make our prisons safer or more stable in the way that we want to see. At the end of the day, Spice is used primarily by very vulnerable populations, particularly rough sleepers and those in prisons. It is used by those whose days are filled with a lethal mixture of boredom and despair. Despite the risk of losing all control and having a terrible time, Spice promises an escape from reality, and the uncomfortable truth is that many of the punishments used in prisons, such as taking away TV privileges or limiting time outside cells, can make that boredom and despair deeper.

[Bob Stewart (Beckenham) (Con)]

I am wondering, with Spice, if there is an animal—a dog—that can sniff it, and how the heck do we trace it? There are people in prison who come in with a problem and there are people who are infected, in a way, with drugs in prison, but the key is to try to find where the drug is located. I am sure the hon. Lady knows that much better than I do, not that she has experience.

[Ms Brown]

No, trust me, I have no experience. That is why I found the Psychoactive Substances Act 2016 rather an exciting piece of legislation to be responsible for. The hon. Gentleman is right and there are many ways, sadly, that Spice can be taken into a prison. For instance, I was told that Spice can permeate a piece of paper. In a four-page letter, one of those pages might have the substance. It can then be torn into little strips and submerged in water, and the compound can be extracted from that. There are many ways that this can happen, and that is one of the reasons why this is so dangerous and why we really do need to be doing all we can to bring some semblance of control over the substances in our prisons and our prison estates.

If we want to tackle Spice in our prisons, as well as shutting down the routes in and ensuring that those who exploit it are stopped, we have to ensure that fewer people actually want to take it. That requires treatment by professionals, a productive and active prisons regime, and the creation of a therapeutic culture in which it is normal to want to be well, to have opportunities and support to be well, and to see oneself leaving prison and leading a productive life.

I am told that the test for psychoactive substances available currently can identify only six elements within the broad category of NPSs, and that updating that test can take as long as a year. I wonder if the Minister can tell us how many more chemical elements the Government think will need to be added in the near future to make that test more effective. I know she might not have that at her fingertips, and I would be grateful for a letter. I would also be grateful for any estimates she might have made as to how these changes will allow testing revisions to be speeded up and new forms of dangerous drugs identified.

Can I also ask the Minister: who will get access to the studies of the prevalence of different substance misuse in prisons in future? She will know that the Prison Officers Association has requested access to these studies so that its members have basic information about which substances are in circulation in their prisons, but it tells me that it does not get a response. Currently, the contract for prison testing is outsourced and held by just one company, Abbott Toxicology. It would be worth while if, during the progress of the Bill, the Government would make available an assessment of the performance of that contract. Is the service this company is providing adequate and is it value for money? Will there be a new contract to reflect the wider range of substances that need to be tested for?

As hon. Members will know, there are occasionally issues with the interpretation of the definition in the Psychoactive Substances Act, which this Bill would copy into the Prison Act 1952. Are the Government confident that the definition in the Bill is robust enough?

What purpose will be left for section 47(3A) of the Prisons Act 1952 after the Bill has amended it? Currently, the section allows the Government to make special rules enabling samples to be required for tests of substances that are not controlled under the Misuse of Drugs Act 1971. However, it now will not be possible, or presumably necessary, to use those powers to enable testing for new psychoactive substances, so what could it be used for? Is there still a point to having that general power in legislation?

The Bill extends the testing regime to cover prescribed and pharmacy medicines, many of which can be misused and cause serious damage in our prisons. They include drugs such as gabapentinoids and prescribed opioids for pain relief, which may be sold or shared with others outside the prescription given by the NHS. This is a welcome change, but close collaboration will be needed to ensure that prisoners who test positive are not mistakenly and unfairly penalised when they have a prescription and a genuine medical need. I note that there are a few points about that in paragraph 40 of the explanatory notes to the Bill, but I ask the Minister to expand on that, either in this debate or when we consider the Bill in Committee, as I hope we will.

It is essential that the testing regime will be the same across each prison and between prisons: from the new entrants in reception, to those in treatment areas, to those in a different prison, to a prison to which the prisoner might be transferred next week or next month. Otherwise, damaging disparities could arise between the results given by a test used in reception and one used by NHS staff in the treatment centre. What reassurances can the Government offer that that will be absolutely guaranteed?

Better testing can do very little when the treatment provision and the healthy rehabilitative regimes and cultures are not there in our prisons. I would be interested to see in the near future an analysis by the Government of how much an expansion of testing would cost. However well intentioned the Bill is—I think it is well intentioned—we need to make a considered assessment of whether additional money might be better spent on more staffing in prison, better access to drug treatment and through-the-gate support, or more rehabilitative prison regimes.

We need to make our prisons free of this poison, which continues to wreck lives. On the face of it, the lockdown in prisons should have made a big difference. There are only a number of possible routes that banned substances can take to get into prisons and two of the main routes have been heavily restricted. Visits to prisons were banned for many months and even now they have restarted they are occurring at a much lower capacity. During that same time, new entrants to the prison system from our courts have slowed to a trickle as a result of court closures and mounting backlogs. I hope the Minister can tell us whether there has, or has not, been a big decrease in access to substances in prisons over the past months, as that should be able to inform us about the routes being used to bring substances in. Perhaps the Minister will be able to tell us what lessons have been learned.

What impact has the lockdown had on the quality and accessibility of treatment in prisons? We know that access to prescriptions has, thankfully, continued with relatively little disruption through the pandemic, but what has happened to the other elements of treatment? Group-based discussions and therapy are always an important part of treatment. Are the Government considering how a wider range of treatment options could be restarted safely, bearing in mind that the risk from the pandemic may continue for many months to come?

I am happy to say that Labour welcomes and supports the Bill, and I congratulate the right hon. Member for Chesham and Amersham again on bringing it to the House. The Bill will create greater consistency across policies and make a change that perhaps should have been made when the Psychoactive Substances Bill went through the House four years ago. I will be delighted to support it today.

Christmas Adjournment

Debate between Lyn Brown and Bob Stewart

Thursday 21st December 2017 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

As the hon. Member for Beckenham (Bob Stewart) said, I often use this debate to talk about women’s health matters in a way that can make grown men wince. I have to say that he and other hon. Members on both sides of the House have been very generous in their support for the hysteroscopy campaign. I am very happy to report that, following a meeting this week with the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price)—it was a very good meeting—I really hope some progress can be made. I thank him and others for their support.

[Bob Stewart]

Is the progress that the hon. Lady mentions pain-free for ladies who have to undergo this treatment?

[Lyn Brown]

The woman Health Minister I met has read the women’s testimonies I presented to her, and she was horrified by them, as the House has been when I have read them out on previous occasions. She and I are very clear that this is about choice—informed choice—and about making sure that women get what they need, rather than what is cheapest. I do not want to put words in her mouth, but I think we are both on the same page, and it was a very happy meeting. I therefore have only three, not four, issues that I want to raise today.

First, NewVIc—Newham Sixth Form College—is a great further education institution that regularly sends more young people from disadvantaged backgrounds to university, including to Russell Group universities and Oxbridge, than any other sixth-form college in England. Newham is a massively deprived area, and research tells us that 13 out of 20 children in Newham live in poverty, and that it is currently second worst of all local authorities in England for social mobility. The fact that our young people are doing massively well at our FE institution is therefore testimony to them, their teachers and their parents. However, NewVIc’s budget has been cut by £770 per student, and that includes £200 per student from the deprivation allocation. How on earth can that be justified?

I would be very grateful to the Minister if he liaised with the Department for Education on my behalf to secure a meeting about this with NewVIc and me so that we can help NewVIc to continue to be a much-needed engine of social mobility in my community and that of my right hon. Friend the Member for East Ham (Stephen Timms).

Easter Adjournment

Debate between Lyn Brown and Bob Stewart

Thursday 30th March 2017 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

I would like to use this debate to highlight three areas where I feel our national health service might do a bit better. The first, regular attendees of this debate will not be surprised to learn, is about the medical procedure of hysteroscopy.

To refresh our memories, a hysteroscopy is when a small device, often including a camera, is inserted manually through the cervix into the womb, usually to cut a sample from the tissue or lining which can be used to help to diagnose cancers and fertility issues. It is usually performed without any anaesthetic. I am told—reassured—by medical professionals that it rarely causes discomfort. However, as we have heard before in this House, it can also be horrifically painful.

This is the fourth time I have raised the issue and when I last spoke I asked for a letter from the Minister to address the issue. I must thank those on the Government Benches for ensuring that such a response was forthcoming. Unfortunately, the response from the Department of Health was, if I can put it gently, bland in the extreme and did not really move the issue forward. I have written again, this time to the Secretary of State for Health. I have asked him or one of his Commons team to meet me and discuss this issue in person. The Secretary of State is not a bad man, so I hope that with the encouragement of the Minister on the Treasury Bench I might be successful.

Since raising this issue in December, I have been contacted by even more women. Given how short the debate is, I will mention only one story. This is from a woman in Leicester, who said:

“The prior information leaflet suggested there would be minimal pain...it was so excruciatingly painful that I began to cry out, my body went into shock and I started to sweat profusely. I came over disorientated and dizzy, I felt heavily nauseous and I began to pass out. I have never experienced agonising pain like it in all my life...when arriving home, I spent a long time crying, curled up in a ball doubled over with pain...the use of no local anaesthesia in this procedure seriously requires investigation.”

[Bob Stewart]

I have heard the hon. Lady on this subject several times before. It deeply upsets me that doctors do not recognise the pain that women undergo and apparently continue to say, “There will be mild discomfort” when women are in agony. For goodness’ sake, this has to be sorted!

[Lyn Brown]

I am genuinely grateful to the hon. Gentleman. He has listened to me, wincing, through the many debates in which I have raised this issue. I know I have genuine support on both sides of the Chamber, so I am hopeful that his Secretary of State will come up with a solution that will enable us to move forward.

A colleague of ours in this place had to undergo this procedure and she was mindful of my words. She attended a central London hospital and, with no little trepidation, asked about anaesthesia. The doctor looked at her with disbelief and said, “They use anaesthesia as a matter of course, because to do anything else would be barbaric.” All we are asking for is that all women get the same care and attention whichever hospital they go to and whichever part of the country they live in.

My second issue is the speed of cancer diagnosis. West Ham has a relatively low incidence of cancer, but patients from my constituency are, unusually, likely to die within a year of being diagnosed. The essential research done by Cancer Research UK makes the primary reason for this clear: too many of my constituents die because successful diagnosis takes too long. To be honest, they also do not get to the doctors early enough to seek diagnosis. Less than half of cancers in the Newham clinical commissioning group area are diagnosed early, significantly fewer than the national average. This problem was highlighted this Wednesday by the “Today” programme on Radio 4. Currently, many patients across the country go through a drawn-out, stressful and expensive process of diagnosis. They may be referred to an oncologist for testing too late, and there is clearly a role for better and more consistently observed guidelines to prevent that.

Even when patients are referred, however, they often face a series of appointments with specialists, waiting for test results between those appointments. Many symptoms of cancer are ambiguous, especially at the essential early stages. A shift in policy towards rapid testing for multiple cancer types could be expected to improve early detection rates, giving more patients a new lease of life, saving patients and healthcare staff a great deal of stress and time, and, indeed, saving the NHS money through the adoption of a more efficient process.

I have personal reasons for raising this issue today. Had such early detection been available a few years ago, my mum might still be with me today instead of leaving us far too soon, and completely unexpectedly, on a Mothering Sunday morning. I give notice that I shall be seeking a longer debate in the House, but, in the meantime, I should be grateful if the Deputy Leader of the House would ask the Department of Health to write to inform me of its current plans to move towards faster and more joined-up cancer diagnosis.

I also have some concerns about plans for a weakening of the link between the recommendations of the National Institute for Health and Care Excellence and the availability of recommended treatments to patients. Access to treatments can already be delayed by 90 days, but under the new rules, approved treatments with a high overall cost—regardless of the cost per treatment—could be delayed by health commissioning authorities in England for at least three years, 13 times longer than is currently allowed. Colleagues in all parts of the House have argued in recent months that the right balance between affordability and equal access to effective treatments for those who need them has not yet been found. I echo that view, and I would appreciate any reassurance that the Government can offer that they are committed to re-examining these issues soon.

I, too, will be remembering Keith Palmer over the break, and I will be thinking of everyone and hoping that they are all safe. I say to all Members, and to all the members of staff who look after us so well: have a great Easter break.

Female Genital Mutilation

Debate between Lyn Brown and Bob Stewart

Monday 10th March 2014 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I want first to congratulate my right hon. Friend the Member for Leicester East (Keith Vaz) and the hon. Member for Mid Derbyshire (Pauline Latham) on securing the debate and to welcome the comments made by the Secretary of State for International Development over the weekend. Both sides of the House will unite on female genital mutilation to ensure that we prosecute those responsible for inflicting such a brutal practice on girls and women, and that we eliminate it once and for all.

Shockingly, an NSPCC survey of teachers reported that one in six are unaware that female genital mutilation is a crime, and that 68% of teachers are unaware of any Government guidance on what to do if they believe that a girl whom they teach is at risk. It is clear from what we have heard over the past weeks and months that we need to increase awareness of the practice among all professionals, such as GPs, midwives, teachers and health care and social workers. To do so, however, we must be more open as a society about discussing women’s bodies and be more comfortable with the language. Open and honest dialogue with boys, girls, men and women about women’s bodies will help to raise awareness and to break down the barriers that cause ignorance and embarrassment. We need to use words such as vagina and clitoris, because the more that we say them, the more comfortable we will become with initiating and engaging in such discussions.

Some hon. Members present will recall that I spoke in the Chamber during the Adjournment debate before Christmas about a procedure called a hysteroscopy, which looks inside a woman’s uterus and is often used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. I must admit that I found it difficult to use words such vagina, uterus and cervix in the Chamber.

[Bob Stewart]

You did it very well.

[Lorely Burt]

Well done.

--- Later in debate ---

[Bob Stewart]

I thank the hon. Lady for her speech. I was there when she spoke in the Chamber and thought that she did tremendously well. Is the unit to which the hon. Lady refers able to visit schools in her constituency to educate both teachers and children to try to stop this abhorrent crime?

[Lyn Brown]

The unit is in its infancy and is currently developing how it will work within the community. I will go on to discuss what the unit expects to do in the next bit of my speech.

When a maternity professional becomes aware of a mother who has been the victim of genital mutilation, they are required to make a referral to safeguarding officials for child protection reasons and to invite the woman to access the genital mutilation prevention service. The service is geared up to support the victims of female genital mutilation to empower them to understand the negative consequences of mutilation and to enable them to become an advocate against the female genital mutilation of their own daughters. The service will provide advocacy for victims, involving extended family and spouses where appropriate, and thereby support women in their own environment to take a stand against the practice.

In answer to the hon. Gentleman’s question, Newham council is training community-based female genital mutilation champions and is supporting victims to report domestic sexual violence to the police. So it is working with women in the community to work with women in the community in order to raise awareness of the act’s illegality.

Holocaust Memorial Day

Debate between Lyn Brown and Bob Stewart

Thursday 23rd January 2014 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is an absolute privilege to participate in this debate. I wholeheartedly congratulate the right hon. Member for North East Bedfordshire (Alistair Burt) not only on securing the debate, but on his deeply moving contribution.

Members on both sides of the Chamber have made some incredibly powerful contributions reflecting on the events of decades ago and pondering their relevance today—and I certainly believe that they are relevant today. We said then that never again would the world stand by while a state killed its own citizens in such a planned and systematic way. Today, and even then, it was unimaginable—completely and utterly incomprehensible —that a state could inflict such suffering and despair by exterminating its own people and those of other countries simply on the basis of a perceived difference.

Yet, as we reflect on the holocaust, how can we not also consider, as has been said, Cambodia, Bosnia, Rwanda and Darfur, where we have seen communities systematically dehumanised and killed because of a perceived difference, whether it be one of race, religion, ethnicity or belief?

[Bob Stewart]

Will the hon. Lady give way?

[Lyn Brown]

Can I not?

[Bob Stewart]

Of course.

[Lyn Brown]

With the help of the Commons Library, I have looked at some of this place’s wartime debates about the holocaust. They make it absolutely clear that there was a high level of awareness of the situation. In a debate on refugees on 19 May 1943, a Home Office Minister said that since the outbreak of the war, 8 million people in Poland had suffered barbarous punishment or death, and many others spoke knowingly of the Nazis’ intention to exterminate the Jewish people.

There is also a palpable sense in these pages of powerlessness with regard to tackling the problems, which were known about, and saving lives. Perhaps that sense of powerlessness has been echoed in this Chamber throughout the decades since. Indeed, I remember the debate on Syria.

In 1939 the merchant ship St Louis set sail from Hamburg with 937 German-Jewish refugees on board, seeking asylum from Nazi persecution. Despite setting off with visas to allow them into Cuba, they were denied access. They set sail for the US and Canada, where access was also denied to them. The St Louis returned to Europe, and at that point the UK agreed to take 288 of the passengers. Others went to Belgium, France and the Netherlands, but following the German invasion of those territories, they were again at risk, and historians estimate that 227 of the asylum seekers on that boat subsequently perished in the holocaust.

What makes the holocaust stand out is not only the sheer number of victims, but the concrete evidence of how the killing was organised and implemented on such a scale. Of great significance is the fact that every Jew was defined not by their religion or their own definition, but by the perpetrators’ definition. Jews were singled out and registered on a central database—its purpose was to expedite their murder—before being publicly marked, stripped of their citizenship, forced to hand over their possessions, dehumanised and, ultimately, deported to their death. I am astonished that the Nazis intended to expand the final solution beyond their borders: they drew up lists of Jews in the USA, Great Britain, Israel and so on. There has never before been such an event in history.

Our political forebears in this place did something, but we have to admit that it was not enough. Debates at that time referred to quotas or the numbers that should come here or go elsewhere in our empire. I am sure the Government of the day thought they were acting for the best, but it simply was not enough. Edmund Burke is attributed with saying that the only thing necessary for the triumph of evil is for good men—and, indeed, women—to do nothing. We said, “Never again,” and we set up the United Nations to promote world peace, but we have still seen enormous inhumanities unfold in front of our eyes. Even today, we see credible evidence of the organised murder on a horrendous scale of the people of Syria by the state.

In preparing for this speech, I was reminded of one by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) in 2008. In it, he reflected on a visit to a museum in Rwanda that commemorates the millions who lost their lives as the world looked the other way. There is a picture of a young boy called David, a 10-year-old who was tortured to death. His last words were, “Don’t worry—the United Nations will come for us”. But, as my right hon. Friend said, we never did. That child believed the best of us, only to discover that the pieties repeated so often, over and over, in reality meant nothing at all. The words “Never again” became a slogan, rather than what they should be—the crucible in which all our values sit and are tested.

My mother, like many of her generation, watched the liberation of the camps on newsreel footage. She was so profoundly moved by what she saw that she ensured that I was educated about it, and she gave me a copy of Anne Frank’s diary when I was about 10 years old. I devoured that book—trying to imagine myself in Anne Frank’s shoes—and I gained a tiny insight into the injustice and inhumanity to which she and her family were subjected. It was a lesson that I hope I have not forgotten. Years later, my mother and I visited Prague. We went to the ghetto, and saw the walls with the names of the 80,000 Jewish victims and the piteous paintings by the children.

I hope that hon. Members will allow me to say that I am neither a moral nor a political coward, but I know myself: I know how that visit, and the ones to Anne Frank’s house and to Dachau, affected me. I have therefore baulked at making the trip referred to by many hon. Members today, but in the light of this debate, I will face up to the challenge and visit Auschwitz-Birkenau before the end of this Parliament with, I hope, the support of the Holocaust Educational Trust.

This year, we mark the centenary of the outbreak of the first world war—the great war, as it was labelled at the time—and we should use the tone of this debate, which I commend, to fend off the revisionism that such occasions sometimes engender. It is widely believed that the treaty of Versailles created the conditions in which fascism emerged into the 1930s, and from which the horrors of the holocaust unfolded. Let us bear that in mind when we assess the events of 100 years ago and let us apply the lessons to our foreign policy when we encounter inhumanity in today’s world.

We know so much about the holocaust. We should be immensely grateful to the Holocaust Educational Trust for providing the resource that we all need. I join others in commending its work and that of Karen Pollock in particular. I am sure that the trust will rise to the challenge of keeping alive and accessible the stories and lessons of the holocaust as the number of survivors sadly dwindles over time. I commend the Government’s continuing commitment to ensuring that the holocaust is never forgotten, including through their funding for the Holocaust Memorial Day Trust under the admirable leadership of Olivia Marks-Woldman. Both trusts play their part in humanising the holocaust. In my view, that is the only way in which we can begin to comprehend such a vast and enduring tragedy.

In the Chamber today, we have heard how Members have comprehended the horror through seeing the piles of shoes or treading the steps into death chambers. For me, it is those paintings by the children in the Prague ghetto. We know so much, and yet we seem to learn so little. As we pause in the week before we mark Holocaust memorial day on 27 January, with its theme of journeys, we should take time to reflect on our global shortcomings and on our tendency to recognise the absolute horror of the holocaust, and yet to allow subsequent genocides to happen with such depressing frequency.

Christmas Adjournment

Debate between Lyn Brown and Bob Stewart

Thursday 19th December 2013 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is an honour to follow the hon. Member for Stafford (Jeremy Lefroy), who has entertained us with a very thoughtful speech this afternoon. I am going to follow up the health theme, but my discussion of it is going to be a little more graphic. If any hon. Ladies or hon. Gentlemen wish to leave, I shall not take it as a personal affront. They might find it more comfortable to go off and get a cup of tea.

I want to talk about hysteroscopy, particularly when undertaken without anaesthetic. This topic was brought to my attention by my constituent, Debbie, who lives in Plaistow. She was diagnosed with womb cancer or uterine cancer last year. She contacted me because the process of diagnosis, rather than the cancer itself, caused her

“the most distressing and painful experience”

of her life. Debbie underwent a procedure called hysteroscopy, which looks inside a patient’s uterus and is used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. Biopsies are often taken and tissue is often removed. The patient’s vagina is opened with a speculum, as during a cervical smear test, and a hysteroscope is inserted. A hysteroscope is a thin tube with a light and camera on the end, as well as any other instruments that might be needed. As I am sure I need hardly point out, this procedure is highly uncomfortable and clearly has the potential to be very painful indeed.

At present, the NHS Choices website explains

“a hysteroscopy should not hurt, but women may want to take a pain killer such as ibuprofen beforehand”.

As well as a hysteroscopy being an out-patient procedure, the NHS website says that

“the procedure can also be carried out under general anaesthetic, which may be recommended if your surgeon expects to do extensive treatment at the same time or if you request it.”

So far, this sounds fairly reasonable: it will not necessarily be pleasant, but there are options and the procedure can be carried out with or without pain relief and with or without local or general anaesthetic.

Let me tell Debbie’s story in more detail. Through Debbie, I have also heard stories from other women across the country. Debbie told me:

“I was in absolute agony. The consultant who performed my procedure knew I was in pain but carried on regardless. A nurse had to push me back down on the bed as I stiffened like a board. She had to hold me there and had hold of my hands too as I was trying to reach down and stop the procedure. All I could think was that if I made the consultant stop, I would have to come back and endure the whole thing again. This procedure, without anaesthesia, is barbaric. It is absolute torture. It needs to be stopped. At the very least, the patient should be informed that it could be extremely painful and have options explained and open for her. That way, she can make an informed decision as to whether to go ahead without anaesthesia.”

[Bob Stewart]

That sounds absolutely horrific. The hon. Lady did not explain whether Debbie was asked whether she would like a general anaesthetic. I presume that she was not asked and that the procedure went ahead without it.

[Lyn Brown]

Her very next sentence explains that:

“I was given no options. I have complained to the PALS department and to be quite honest I am not happy with their reply. At one point it mentions that the hospital gets more money for the procedure to be done as an outpatient! Is this what it boils down to? Money? Disgusting!”

Jan from Cheshire said:

“I had a hysteroscopy in Cheshire. This hospital is a private hospital but I was there as an NHS patient, as it was the hospital that my doctor could get me into the quickest, for investigations into abnormal bleeding. I saw the consultant in September of 2011, and was given an evening appointment to attend for a hysteroscopy, and was told that the procedure would be done under local anaesthetic. At the evening appointment, I was given a local anaesthetic, but after several attempts at performing the hysteroscopy, the consultant apologised and said that she was unable to perform the procedure and did not want to attempt it again under a local anaesthetic as, in her words, ‘it would be inhumane to continue under a local’. I was sent home and told to take co-codamol for pain relief, and that I was to return the next day for the procedure to be done under a general anaesthetic. I have got to say that even though I had a local anaesthetic”—

if Members have been paying attention, they will know that my constituent Debbie was not offered that—

“the procedure was still very uncomfortable and painful. I have to say that I think offering a hysteroscopy without any form of anaesthetic is barbaric.”

Jo from Chesterfield said:

“I had already had biopsies done in clinic with no anaesthetic, done like a smear with swabs but going through the cervix. I had found this painful but nothing prepared me for what was to come. I had been given a leaflet to outline the procedure but it mentioned nothing about pain or discomfort. I was asked to go behind a make-shift cubicle in the corner, take everything off and put on a gown. I was then asked to sit in a contraption that looked like some Victorian birthing chair, it was very uncomfortable and awkward to sit in. I felt so undignified…I have never felt such pain. I felt like my whole abdomen had been blown up, the pressure was so intense, then sharp prodding pains, I had tears in my eyes, the nurse did come and hold my hand. I just looked at the ceiling and held my breath, praying for it to be over.

When he’d done, the doctor asked ‘did you find that a bit painful?’. I replied ‘no it was excruciating’, he just remarked that most women are fine with it but perhaps I had a low pain threshold and that if I were to need further treatment I would need a General Anaesthetic as I was sensitive. I was quite gob smacked and in so much pain I didn’t really reply. I struggled to my car and drove home, I was in agony for days. I felt almost like I’d been violated, like a piece of meat, but thought perhaps it was just me, perhaps I was being a wuss. It wasn’t till I spoke to other ladies that I discovered it needn’t have been this way. My treatment on a whole I feel was done very wrongly, cutting corners and saving money, at my expense. The hysteroscopy should not have been done this way, it’s almost inhumane.”

Katharine from Bath said:

“My GP referred me for day-case hysteroscopy under local anaesthetic…He told me to pay for a course of Cognitive Behavioural Therapy to lower my Blood Pressure to qualify me for NHS day-care surgery as opposed to more expensive NHS inpatient surgery. During the Cognitive Behavioural Therapy the psychologist told me to go straight to the gynae-oncology surgeon at the hospital and have my persistent inter-menstrual bleeding properly investigated. My GP was furious at this suggestion but eventually gave in. The gynae-oncology surgeon told me that ‘you’ve had it for so long it won’t be anything sinister’. He eventually agreed to an inpatient hysteroscopy under General anaesthetic. I waited months for the operation. It showed late stage womb cancer which had spread to the lymph nodes. I had a radical hysterectomy and a long course of external radiotherapy”.

Jenny from Barnsley said:

“I went into the clinic and was given an ultrasound and very quickly was approached by a senior registrar who said I had a very thick womb but they could do a biopsy there and then.

My GP had mentioned that this procedure can be difficult but they would give me a local anaesthetic.

To be honest I was in such shock. I was led into a room where there was a very nice sister and nurse. I sat in a chair and the senior registrar began by filling my womb with water.

Then the hell began when they inserted whatever and did the biopsy. I have not experienced such pain even in childbirth and I told her so. I also said my GP had said they would give me some local anaesthetic and then she asked if I wanted some. Rather like closing the stable door after the horse has bolted. It was too late then as they were in there.

The sister told me she nearly stopped the doctor. They were very caring then but only offered me one paracetamol. They said to me don’t let the woman who is waiting outside see you or it might put her off.”

The 21-year-old sister of Michelle, from Scotland, went for a hysteroscopy after noticing some bleeding after intercourse. The gynaecologist asked a nurse to assist while he proceeded to perform a rather forceful examination, and then carried out the hysteroscopy with no warning or pain relief. Michelle received a phone call from her distraught sister, who had gone into shock in the car park, had passed out next to her car, and was bleeding.

Gillian in Leeds said:

“Before the procedure, I received a leaflet with my appointment letter—no mention of any general or local anaesthetic, but after what the doctor had told me I wasn’t expecting it to be too bad”.

She said that the nurse

“managed to get the hysteroscope through my cervical opening…when she took each sample—6 in total—my pain level shot through the roof.

“What...infuriates me most is the fact that SOME people are given pain relief as a matter of course at their hospitals…why the hell should I, and others, have to suffer just because of which hospital we went to?”

Patricia from Fife said:

“I was offered no pain relief and the Dr. who did it didn’t get enough in the end so I had to go under general anaesthetic to get it done again.”

The procedure that she experienced, while conscious,

“was very traumatic and painful…I felt them cutting away the biopsy inside…afterwards the nurse who had held me down said to me ‘I wouldn’t have let them do that to me without a general anaesthetic’ so why did she let me go through it?’”

Maureen from Norwich said:

“The letter…advised I took either ibuprofen, or paracetamol about two hours before the appointment. The scan showed something abnormal, so I waited and then saw a very nice lady doctor. I then went on to endure the procedure, it took about fifteen minutes and it was certainly a lot more than uncomfortable.”

She felt very sick, and was in pain, but

“the nurse who was there kept saying how well I was doing. I was at the limit of my endurance, only the thought of having to go back again stopped me from asking the procedure to be stopped.”

I have received so much correspondence about this issue, via my friend Debbie, that I could speak at length and give many more examples, because what I wanted to do today was give those women a voice. However, I think that the House will understand the direction in which I am going.

Some women have received no pain treatment at all—no anaesthetic to dull the pain. Some have received a local anaesthetic, but, given the severity of their conditions, a number of them have found that that is not enough. Others have received a general anaesthetic, either on request or because their doctors were aware that the procedure involved might be more extensive than had been expected. A study of a group of women conducted over five years in Melbourne established that over 10% of the group would not accept a local anaesthetic again, because of the pain and the need for the procedure to be repeated owing to a failure to secure a biopsy sample.

I have found it difficult to obtain information about this issue, but I think that certain facts are clear. Some women are being given no pain relief options at all. That aspect is not being explained to them by the doctor when they get to the hospital. Some feel that they are not being treated with compassion and respect, and that very little or no consideration is given to their dignity or their well-being. Some are experiencing a procedure that fails and needs to be repeated. One has to ask how often that happens, and what the cost is to the NHS.

Some women are clearly receiving treatment that is not in line with the guidelines issued by the Royal College of Obstetricians and Gynaecologists, which acknowledges that

“outpatient hysteroscopy can be associated with significant pain, anxiety and embarrassment”.

While the RCOG’s guidelines emphasise throughout that it is possible for women to have an acceptable out-patient experience, and some women do, there is clearly a serious problem, in that the current standard practice is failing a significant group of women very badly. It is appalling that, in some cases, no pain relief is even offered. I have read a range of the information leaflets that various hospitals offer to support their hysteroscopy out-patient clinics, and I am glad to note that local anaesthetic is mentioned in almost all of them, but they are not open enough about the pain that women may experience during and after the procedure, and there is inadequate reference to the option of undergoing the procedure with a general anaesthetic.

[Bob Stewart]

May I ask what percentage of women feel no pain whatsoever? Is there such a percentage, or does everyone experience pain—in which case, we must sort the matter out?

[Lyn Brown]

I honestly cannot answer that question, although I can say that at the different times in my life when I have had internal examinations the pain has varied, and that as I have got older, the examinations have become more painful. I have been told by some women who have had babies—which, sadly, I have failed to do—that they have found the examinations less painful after their pregnancies. However, some have told me that they become more painful with the menopause. Indeed, when my mother had a similar examination, she told me that it had been excruciating, and that was when she was quite old.

I am not sure that there are any research findings out there that would answer the hon. Gentleman’s very sympathetic question—certainly I have not found any—and I think that this is something that we need to know more about. However, a study published by the British Medical Journal in 2009 concluded that a local anaesthetic injection was the best method of pain control for women undergoing hysteroscopies as out-patients.

I have struggled to decide what I need to ask the Government to do in order to ensure that women receive the best possible care and treatment while undergoing this procedure. It is difficult for me to know that, because I am not a medic. However, I do think it is reasonable to ask the Government to use all the influence they have over policy in this area to require the National Institute for Health and Care Excellence to work with the Royal College of Obstetricians and Gynaecologists to issue authoritative guidelines. I also think the Care Quality Commission may well have a role to play in ensuring that best practice is delivered locally at each hospital.

Apprenticeships and Skills (Public Procurement Contracts) Bill

Debate between Lyn Brown and Bob Stewart

Friday 1st November 2013 Commons Chamber

[Lyn Brown]

I absolutely agree, and I am grateful to my hon. Friend.

The London Legacy Development Corporation is aware of the transient nature of the work force in sectors such as construction and has asked its contractors to monitor the length of their workers’ residency. When we were building in preparation for the Olympic games, we were keen to make sure that local people, who were being severely disadvantaged by the construction process, were able to take advantage of the opportunities that came their way.

We set up lots of monitoring schemes to find out whether the people getting the jobs and apprenticeships came from the area. Unsurprisingly, people moved into the area to take up the jobs and apprenticeships and then moved out, taking with them their skills and spending power. That, obviously, is not great; we wanted to transform the local area and make sure that local people had the advantages.

[Bob Stewart]

Has the hon. Lady any idea of how many people who were apprentices for the Olympic build successfully moved into permanent employment as a consequence of that training? Do we have that figure?

[Lyn Brown]

I am not sure whether the figure is available, but I will check that out and pass a note to the hon. Gentleman as it would interest me too. However, we did discover that apprentices based in Salford, Gateshead and Newcastle came with their firms to the Olympic park to complete their apprenticeships. Although we got additional apprenticeships, the Olympics provided opportunities for companies based elsewhere in the UK to bring their work forces down and keep them employed while we waited for the worst of the recession in building to move on or for additional work to be found.