Mental Capacity (Amendment) Bill [Lords]

Madeleine Moon Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant]

I will speak to amendment 1 and the three other amendments in my name and the names of several colleagues.

I want to start with enormous praise for the national health service, which in many cases makes the key decisions on everything that we will talk about today. Sometimes those are very difficult decisions, including for families, and they need to be managed with care and sensitivity. Ensuring that we have the right law in place to enable clinicians to make the right decisions is vital. I was on the Public Bill Committee for the Mental Health Act 2007 under the Labour Government, and I remember many of the rows and difficulties then. Ensuring that legislation fits the complicated circumstances of real life is not all that easy, and in particular, the definition of what might be proper treatment is not readily come by.

Often lobbyists get a really bad press. My experience of lobbyists in this field is entirely positive, including those working for the pharmaceutical industry, who do an amazing job in providing new drugs that can save people’s lives and manage their conditions much better, and the many charities in this field. When lobbyists are decried, I sometimes want to point out that they play an important part in ensuring that Members of Parliament know exactly what they are doing when it comes to legislation.

All the amendments that I have tabled relate to acquired brain injury. I am aware that several other colleagues who are members of the all-party parliamentary group on acquired brain injury are here today. I do not want to make an apology for that, but I want to explain why I have tabled these amendments. It is partly because I believe that acquired brain injury, though recognised and understood by some, is something of a hidden epidemic in Britain.

Something like 1.4 million people in this country are living with an acquired brain injury. A new person presents at accident and emergency with a brain injury every 90 seconds. Many of these injuries have lasting effects that are completely invisible to an ordinary member of the public. For instance, the person standing in front of us in a queue who is being difficult might look as if they are drunk or just being difficult, but they may have a brain injury. We would have no idea, and the person feels trapped and finds the situation as difficult as we do. The more we come to an understanding of acquired brain injury in this country, the better.

There are many different causes of brain injury, including road traffic accidents, accidents about the home and stroke. One cause that has been brought home to me recently is carbon monoxide poisoning. Not only the high level of carbon monoxide poisoning that follows an incident, but a sustained low level of carbon monoxide due to poor central heating systems or facilities or something like a Calor gas burner in a home, can end up causing a long-term brain injury. This particularly affects some of those who live in the worst housing in the land, and who are the poorest and least able to afford, for instance, to have their boiler mended or assessed every year.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is my hon. Friend aware of the problem that some members of the armed forces face with acquired brain injury? It may be because they were involved in or close to the explosion of an improvised explosive device, or because they had a gunshot wound, when the head covering was hit but not penetrated, and the shock can lead to acquired brain injury.

[Chris Bryant]

My hon. Friend makes a very important point. I know the role she has played, in particular in the all-party group on the armed forces, and of course in the NATO Parliamentary Assembly. She is absolutely right, and there are sometimes coup and contrecoup elements of damage to the brain. There is also some evidence to suggest that some people diagnosed with post-traumatic stress disorder have actually been suffering from a brain injury.

Interestingly, the Ministry of Defence has done some of the most innovative work in relation to brain injuries—physical brain injuries, as it were—and it has been able to transfer some of the skills and research involved in that work to the wider population, which is all to the good. However, I think that the way in which the mind sits inside the brain and the brain sits inside the skull is one of the areas of research that is still underdeveloped, and we still need to do a great deal more about it.

Other causes include brain tumours and chronic traumatic encephalopathy, where somebody may have had a series of relatively minor concussions. There is a complete misunderstanding of what concussion actually involves, particularly in sport. This might be leading to some of the long-term sustained problems of, for example, people in my own constituency who played rugby for many years and had repeated concussions. They may suffer from dementia, depression and anxiety in later life, but have no understanding that that may relate to a brain injury, rather than to anything else.

--- Later in debate ---

ABI, or acquired brain injury, can affect many different aspects of mental capacity. There is short-term memory, which is important for knowing to turn up for the meeting; long-term memory, which is being able to recognise the decision we made last week or month and its consequences; and emotional regulation, which is being able to deal with anger and other emotions that may wash over us. Some of those may be more difficult to regulate when someone has had a physical injury to the brain. Then, of course, the executive function—the capacity for planning and organisation—may be harmed as well.

[Mrs Moon]

My hon. Friend is being generous in giving way. One of the things that concern me most is that it is easy to label someone with any form of brain injury—whether dementia, Parkinson’s or anything else—when they also have an infection. What can be seen as difficult behaviour can be misunderstood when it is caused by the infection rather than by any acquired injury or illness.

[Chris Bryant]

Yes. People will also attribute bad intention to the person when what is happening is that the short-term memory is simply not functioning properly. For instance, someone with very little short-term memory may find it difficult to turn up on time, as I mentioned earlier. That may be not because they are being lazy, truculent or difficult but simply because their brain does not work in that way. It may mean that their capacity is so diminished that, according to the Bill, they cannot make decisions. Alternatively, it might just be one of the elements that needs to be dealt with—they need to find tricks to circumvent the problem, and medical and clinical professionals can help.

This is why I tabled my amendments. Neurorehabilitation, when done well and on a sustained basis, can take an individual from being low functioning and high dependency, perhaps needing three or four people just to be able to wash themselves, clothe themselves and provide for themselves physically, to a much higher level of personal functionality and much greater independence. I have made that argument from a different place, in the sense that taking someone from needing four people to look after them to just one person coming in once a day for an hour or so could be an enormous financial saving to the taxpayer. That is why neurorehabilitation and the work that has been done in many cases can be so important.

Neurorehabilitation is really important in relation to the Bill. We might be able to take somebody from a place where they are not truly able to make a decision about what treatment they should be undergoing and, according the Bill, deprive them of their liberty, to a place where that would no longer be appropriate. My anxiety is that if there is no incentive in the system to ensure that neurorehabilitation is provided to people, there is a danger that we just discard them and leave them by the side, particularly as we are now talking about a three-year term rather than a one-year term. I think the clauses at the end of the Bill militate in favour of renewal, rather than providing a clear option not to renew at that point.

I have an anxiety that perhaps in some care homes and other places there just might be an incentive to think, “Well, this person isn’t going to get better so we’re not going to do anything to try to help them to get better.” I do not want to give up on so many people. Thanks to what the Government have done with the major trauma centres, we now save about 800 or 1,000 more lives every year following road traffic accidents and the like, but we need to give people quality of life. We do not have enough people working in this field. We need to recruit many more people. If 20 people were inspired by what we are talking about today to go and work in that field—there are so many high rewards for people working to take people from high dependency to low dependency—that would be a success in itself.

--- Later in debate ---

[Caroline Dinenage]

The wishes and feelings of the vulnerable person are at the centre of the Bill, and the wishes and feelings of their family will definitely be taken into consideration if their family is the approved person. We must always leave a little space in case the person does not want their approved person to be a family member for whatever reason.[Official Report, 13 February 2019, Vol. 654, c. 8MC.] The wishes and feelings of the individual must be at the heart of this, and that was at the heart of the original Mental Capacity Act 2005.

[Mrs Moon]

Does the Minister agree that one of the most essential things everyone should do while they are well is make sure they take out an enduring power of attorney that names the person they want to oversee their health and wellbeing should they be in a situation such as this? Also, many families are intimidated into making bad decisions out of fear that the care home might say, “If you don’t do as we say, or if you complain, move your parent.” Giving power into the hands of care home managers is a very dangerous situation.

[Caroline Dinenage]

As a Justice Minister, I was responsible for lasting powers of attorney and we spent a lot of time trying to convince people to make those sorts of decisions for themselves as early as possible.

Social Care Funding

Madeleine Moon Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

Indeed. My hon. Friend makes a really good point. I noticed that the number of delayed transfers of care due to care packages has started to rise, even though it is not fully winter—[Interruption.] Yes, they have, over the last couple of months. The Care Quality Commission has said that in some parts of the country the social care system has now reached the tipping point that of warned of two years ago.

The response from the Secretary of State was to announce that £240 million would be given to councils to deliver packages of home care to people this winter. That is nowhere near what is needed. The social care funding gap is already over £1 billion this year and, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, it will reach £2.5 billion by 2020 unless the Government intervene.

By my calculations, the Government’s offer will provide only three months’ of care packages for 70,000 people, so when the Secretary of State gets to his feet, will he tell us what will happen to people who need publicly funded home care when the money runs out? What plans do the Government have to provide care beyond the winter?

[Mrs Madeleine Moon (Bridgend) (Lab)]

For some people, it is not possible to wait for money to be available. A third of people who are diagnosed with motor neurone disease will die within one year and over half will die within two years. A delay of a matter of weeks can alter someone’s pathway towards death. Does my hon. Friend agree that there is no time to delay?

[Barbara Keeley]

I very much agree. In recent months, I have met carers of people with MND and one becomes aware of how much time presses on them.

Our motion deals with social care funding, but this debate is really about people, such as the people my hon. Friend just referred to. It is about how society treats older and younger adults, how we should enable them to live independently and with dignity, and how this Government are badly letting them down. I will look today at the damage caused by Government inaction—damage to vulnerable people who rely on social care to live with dignity, damage to the lives of unpaid family carers who have had to step in to care for their friends and relatives, and damage to 1.4 million hard-working care staff, many of whom are so badly paid and so overworked that they cannot deliver the care that people need.

Oral Answers to Questions

Madeleine Moon Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.

[Mrs Madeleine Moon (Bridgend) (Lab)]

So many GP practices—no matter what salaries or what terms and conditions they offer—are reporting a reluctance by newly qualified GPs to go into GP practice. What will the Minister do about the hours of work—the time given to consult with constituents—to make it easier for people to see GP practice as a viable opportunity to serve their community?

Social Care

Madeleine Moon Excerpts

Wednesday 25th April 2018 Commons Chamber

[Dr Whitford]

Many relatives and patients complain about the fact that, depending on which illness people have towards the end of their life, they will either be supported in an NHS or hospice system or they will pay for it in the social care system. A fragmentation has resulted from the Health and Social Care Act 2012 and the change in structure. Someone’s treatment may be delivered under NHS England as a specialist service for so many days, but then they go back to the clinical commissioning group and the ongoing care is suddenly not there. It is all very disjointed. In actual fact, we require an entire approach that joins up health and social care for the entire patient pathway. We should not expect patients to navigate from one pothole to the next.

We have exactly the same challenges with an ageing population. Indeed, the Scottish population is older and ageing more quickly than the English population. In all these debates, I always say that we must not look on this as a catastrophe. Having spent over 30 years of my life trying to get people to live longer, I ask Members to remember the alternative—living shorter. However, without public health changes and a game-changing approach, we are not ageing well; and we need to age well. But that will take a long time to turn around. We need to look after the people who require care right now.

Having failures in social care traps people in hospital. In Scotland, although we have a long way to go as well, delayed discharges from hospital have dropped in every year since 2014, when the integration started. Between 2010 and 2017, the average hours delivered through home care have doubled from six to 12 per week. In future, a quarter of us will die in a care home, so what kind of quality of care do we want to have, and what kinds of palliative care skills would we like our nursing homes and care homes to have? We need to create links between the hospice movement and care homes so that those skills and that supportive approach are shared.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The hon. Lady’s dedication and work in the NHS knows no bounds. One of the things that no one has touched on is the absolutely vital importance of aids and adaptations that allow people to go home and have social care, or even have their family provide care. Often one of the major problems with delayed discharge is the lack of access to those adaptations—the commodes, the hoists, the hospital beds and the walk-in showers that people need in their home. Does she recognise that that is one of things that nobody is talking about that we must get right, and that money must be put in to make it possible?

GP Recruitment and Retention

Madeleine Moon Excerpts

Wednesday 28th March 2018 Westminster Hall

[Several hon. Members rose—]

[Mrs Madeleine Moon (in the Chair)]

Order. Before calling Jim Shannon, I advise hon. Members that I intend to start calling the Front Benchers at 3.28 pm, so I expect you to divide the time accordingly. I call Jim Shannon.

--- Later in debate ---

[Dr Whitford]

On a point of order, Mrs Moon. I have a factual correction to make. The hon. Member for Aberdeen South (Ross Thomson) stated that only 51% of students at Scottish universities were from Scotland. In fact, it is 70%.

[Mrs Madeleine Moon (in the Chair)]

I am sure that information will have been gratefully received.

Question put and agreed to.

Resolved,

That this House has considered recruitment and retention of GPs.

Psychosis: Early Intervention

Madeleine Moon Excerpts

Thursday 15th March 2018 Westminster Hall

[Luciana Berger]

I thank my hon. Friend for raising that important report and the campaign, which I have considered as well. The National Childbirth Trust makes an important point about the connection that GPs have with new mums and their babies. I recall that my GP did ask me about my mental wellbeing and how I felt, but that is not the case for every mum. It is something that we should consider, along with ensuring that every contact counts when it comes to new mums and their babies—be that with the health visitor, a midwife who might come to the home or someone in the hospital. We need to look at the whole spectrum of engagement to ensure that we consider the mental health of mum and baby every step of the way.

I mentioned mother and baby units, which are incredibly important. For anyone who does not know, they are an opportunity to ensure that if the mum is experiencing a period of psychosis or another serious mental illness, they are still able to be with their child. The units offer extremely specialised care and incredible attention from clinicians, who do a remarkable job of ensuring attachment so that mums are not disconnected from their babies, even if they have to be moved across the country.

Mother and baby units are very important for recovery rates. I have asked several parliamentary questions about them, but I want to ask more in the context of this debate because of their importance to mums who experience post-partum psychosis. In January, I asked the Secretary of State, in a written question,

“how many mother and baby beds commissioned by NHS England Specialised Services in 2016/17 are (a) available and (b) in use.”

I asked that because although we know that beds have been commissioned, it is not clear whether they are available or in use. The figures that I received in response to a previous question showed a decrease of one in the number of beds available across the country since 2010. I ask the Minister the same question again, publicly, because her response in January was:

“The information requested is not available.”

I do not think that it is a difficult question to answer. In the context of this debate, it is a very important one, so I hope the Minister’s officials will provide her with an answer today. Post-partum psychosis, no less than any other kind, requires early identification and early intervention, but we are not doing enough to treat or support post-partum psychosis alongside other forms.

Let me conclude with some brief questions that I hope the Minister will address. First, what steps is her Department taking to address mental health inequalities and the waiting times postcode lottery, particularly in cases of early episodes of psychosis?

Secondly, how can the Minister guarantee that money allocated for mental health services is actually reaching the frontline in all the areas in which it is needed? There are many examples of mental health budgets being raided to pay for other parts of the NHS.

Thirdly, does the Minister agree with the Royal College of Psychiatrists that we need to improve the financial data available for early intervention in psychosis services? Without it, we cannot be sure that services are properly investing in EIP.

Fourthly, does the Minister believe that frontline mental health services have adequate numbers of staff—including psychiatrists, mental health nurses and therapists—to meet the targets set out in the five year forward view? I echo the praise of other hon. Members for our frontline clinicians, who do an incredible job under very challenging circumstances but are severely stretched, as we hear time and again. They cannot meet the workforce challenge alone.

Lastly, what steps will the Minister take to drastically improve early intervention in cases of post-partum psychosis, especially at the six-week check for new mothers, so that we can support women in the first weeks after the birth of their baby?

I congratulate the right hon. Member for North Norfolk again on securing the debate. Let us hope that our deliberations this afternoon will lead to concrete improvements and swift action from the Government to prevent unnecessary psychosis, intervene early to prevent unnecessary suffering, and help as many people as possible across the country towards a meaningful path to recovery.

[Mrs Madeleine Moon (in the Chair)]

I will call the first Front-Bench speaker at 2.30 pm.

Social Care

Madeleine Moon Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

Absolutely. My hon. Friend mentions the expert panel, and it is important that we take the advice of those who have front-end experience of the sector. As he says, this is not just about money; it is about quality and getting the right blend of packages of support and help. We really need to think about achieving the best possible care for individuals, as well as how that care is paid for.

[Mrs Madeleine Moon (Bridgend) (Lab)]

A recent Barnardo’s report showed that two thirds of child carers start caring in primary school, some as young as four, with long-term damage to their mental and emotional health. Will the Minister ensure that one of the Government’s primary responsibilities is to tackle the issue of child carers and take them out of a responsibility that we really should not be placing upon them?

[Jackie Doyle-Price]

I thank the hon. Lady for those comments. She highlights what is literally the Cinderella in this debate. It is appalling that so many children are acting as carers, stoically and fantastically but, as she says, to their long-term detriment. As a society, we would be failing if we did not do more to support them.

Autism Community: Mental Health and Suicide

Madeleine Moon Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

I agree. Our police are on the frontline and they deserve the utmost respect for the work they do, but yes, it is correct to say that they require further training and also further support. There requires to be a clearer pathway when people exhibit challenging behaviours in the community, from the point at which the police are put into contact with them right through to the provision of adequate support in the health system, without their being caught up in the criminal justice system in between.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The hon. Lady will be aware that the societal body that is most likely to come into contact with someone who is likely to take their own life is the police. The police, and particularly the British Transport police, are doing critical work in assessing how staff can be trained to identify potential suicides and to take action to take people back at a time of crisis in their life in order to prevent them from taking forward a suicide. We should not knock the police too much. They are doing fantastic work in this area.

[Dr Cameron]

I wholeheartedly agree. As I said, the police are on the frontline. They face the crux of the matter when it comes to matters of life or death. They are doing their very best with the training and resources that they have, but there requires to be a clearer pathway so that people who are at that crisis stage can access health services—and probably crisis health services—and so that the police have somewhere to ensure that the clinical needs of those people are met. It is unfair for our police to have to take care of people’s clinical needs when that is not what their training provides for.

In 2016, an academic study in Sweden, which was published in the British Journal of Psychiatry, found that people with autistic spectrum disorder were nine times more likely to die by suicide than the rest of the population. The latest research indicates that people with autistic spectrum disorder account for a harrowing proportion of suicides in the UK. There is a 16-year gap in life expectancy between people with autistic spectrum disorder and the general population. To put it all very bluntly, people with autistic spectrum disorder are 28 times more likely to consider suicide than the average population —28 times. The statistics make one thing abundantly clear: what we are doing now to support people with autistic spectrum disorder is not working and is not enough. Research shows that almost seven in 10 people with autistic spectrum disorder experience mental health issues, including anxiety and depression. Services must be in place to ensure that people are cared for holistically. We have to meet all their clinical needs, which may mean their autism or their learning difficulties, but they will almost certainly have mental health issues. Quite frankly, we do not have services in place today that take account of the complexity of such needs.

What types of things are going wrong for people at the frontline? It is difficult for people with autistic spectrum disorder to access mental health support through the usual routes. For most of us, that might mean going to our GP as a first point of contact for primary care for mental health problems, but a GP practice is a daunting, unfamiliar place for people with autistic spectrum disorder. One young man wrote to me and described a recent trip, saying that it was

“quite hard for me to access the GP anyway. The whole environment is difficult. It’s noisy, there’s often children, it’s very hot. There’s also a loud beep when they call the next person that I find really quite painful. When you’re feeling emotionally poorly that becomes almost impossible.”

GP surgeries make reasonable adjustments for wheelchair users every day—simple changes that make the life of the patient easier—so the same policies should be implemented for people with autistic spectrum disorder. We need training to raise GP awareness. Access needs to be easier. We need to ensure that GPs know who on their register has a diagnosis of autistic spectrum disorder.

If an autistic person bypasses the GP and goes straight to mental health services, they may face unprecedented waiting times or they may simply be refused treatment. When individuals do attend services, they may find that they are discharged without any follow-up. At the Health Committee last week, we heard how a young autistic boy was turned away by child and adolescent mental health services four times, despite feeling suicidal, because he had not yet attempted to take his own life. Things have hit crisis point, and we need to ensure that we engage in prevention. Someone attempting to take their own life should not be the point at which they receive treatment. We need early intervention to pinpoint the symptoms of difficulty and where we should be aiming the treatment.

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I add my thanks to my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I think I am the first person to pronounce the name of her constituency correctly. I am pleased once again to participate in a debate about autism, a condition that, as we all know, for too many years has not been sufficiently recognised or its challenges fully appreciated. That is starting to change, which is good news for all who are living with autism and who have been either not recognised or misunderstood for too long.

Autism is not a mental health condition, but autistic people are more likely to develop mental health problems such as anxiety disorders, OCD and depression. That is for a host of reasons, such as not being supported and experiencing social isolation. Research shows that a diagnosis of autism can lead to an increased risk of mental health conditions.

Support for those living with autism is very important, as has been widely recognised in the Chamber this afternoon. Anxiety disorders are very common among those on the autism spectrum. Roughly 40% have symptoms of at least one anxiety disorder at any one time, compared with around 15% of people in the general population, and such disorders in themselves can lead to depression.

It is very worrying that young people living with autism are 28 times more likely to consider suicide than other young people are, and it also affects adults who have not been diagnosed. There is no doubt that people with the condition have an increased risk of suicide, as my hon. Friend has pointed out. That could well be because 66% of autistic people and 67% of their families have reported feeling socially isolated.

[Mrs Moon]

Does the hon. Lady recognise that another major problem for families of autistic children is that should one of their children take their own life, the postvention support—the after-suicide support—is not there either, so the social isolation that they experienced in life continues after death and complicates families’ grief? That area must also be tackled.

[Patricia Gibson]

I absolutely agree with the hon. Lady’s excellent point. Should such a tragedy occur and a suicide take place, it is important that the family is supported through that as much as possible.

Some 70% of autistic people are reported to have mental health disorders, such as anxiety or depression. As we have heard, suicide is one of the leading causes of death in the autism community, and that alone tells us that this issue demands our attention. As the hon. Member for Blaydon (Liz Twist) pointed out, diagnosis is important because it should be the foundation on which effective support for autistic individuals and their families is built. Similarly, a delay in diagnosis can hinder effective support and prevent intervention strategies from being put in place.

The National Autistic Society Scotland reported in 2013 that 61% of those it had surveyed said they felt relieved when they received a diagnosis, because such a diagnosis can end years of feeling misunderstood and isolated. We have talked a lot about this as a UK issue, but as a Scottish MP, I want to mention the Scottish Government’s strategy for autism. The strategy, which is based on research, is working to improve waiting times for diagnosis and assessment to create consistent service standards across Scotland, and is providing training opportunities. The entire autism spectrum needs to be addressed, as well as the whole lifespan of people living with autism in Scotland. This is the logic behind this autism strategy, so it is a very positive step.

We have heard about initiatives such as autism hours in supermarkets and special autism-friendly cinematic screenings, and these are all very important and positive steps. There is a greater awareness and understanding of autism in this country but, as we have recognised today, we still have a long way to go. I will end by saying that we often think of those with autism as finding it difficult to see the world as we see it, but the truth is that we need to see the world as they see it, because if we do so we may then be able to start to make real progress.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I have greatly enjoyed listening to the debate, because I have heard so much good common sense and so much passion and care expressed about this important issue. It has been a pleasure. I am glad that we reached it in the end, although it was slightly truncated.

I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and I congratulate all the other Members who have participated in it. Everyone was absolutely right to say that we need to understand more about mental health, autism and suicide, and to understand more about what constitutes appropriate mental health treatment and treatment for people with autism. The existence of the suicide statistics, unpleasant as they are, demonstrates that we really must do better in this regard.

As I have said, I enjoyed all the speeches today, but I pay particular tribute to the hon. Member for East Kilbride, Strathaven and Lesmahagow for the expertise and the personal passion that characterised her arguments. She has given me a lot to think about, but let me reaffirm to her that my door is always open so that I can hear more. I particularly want to hear what the strategy in Scotland has delivered, because she is absolutely right: when we see good practice, we should all share it and ensure that it becomes the norm for everyone.

We can never debate autism without considering the issue of waiting times, and, as Members have pointed out, in some areas they are very poor indeed. As we have confirmed, we will be publishing more data from April which will provide us with the tools with which to “give challenge”. However, it is clear that waiting times are not good enough, especially in the north-east, and we are failing people when we do not give them an early diagnosis.

The hon. Member for Cardiff West (Kevin Brennan) mentioned the criminal justice system, which is where people with autism and mental health issues often end up. As he said, we need to improve the sensitivity with which the criminal justice agencies deal with such conditions. I can tell him that the Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop new guidelines to help officers to support people. I think I need to do more with the MOJ to ensure that we do not put people in a setting that will damage them further, but I am pleased that there are now liaison and diversion services covering 80% of the country to achieve exactly that.

The hon. Member for East Kilbride, Strathaven and Lesmahagow also described very well, as did the hon. Member for Washington and Sunderland West (Mrs Hodgson), how for some people with autism accessing support from GPs can cause distress in itself. This is where debates such as this can be so useful, because sometimes the most simple, practical things can make the biggest impact. It surely cannot be beyond the wit of any of us to make sure that GPs receive appropriate advice about things like lighting, and even having a quiet area. We often now have multi-service GP and health centres, and there must be space in them to have a quiet area.

[Mrs Moon]

One of the risks is that, rather than going to their GP, people will look on the internet, where, sadly, they will find far too much information about how to take their own life and what methods to use. Also, if they go into chatrooms to share, they find encouragement to take their own life. This is an area that we must tackle.

[Jackie Doyle-Price]

I thank the hon. Lady for that intervention and the work she does in this area; I know she cares about it a great deal. She is absolutely right that there is a serious vulnerability among people who feel uncomfortable about accessing medical care. We must consider the proximity of the internet where it is possible to buy drugs and where nobody really understands what they are buying. We can do a lot more to enable people to protect themselves. The internet is a great source of information, but it can be less than benign when people want to use it for these purposes.

I have limited time and know I will not be able to do justice to all the contributions to the debate, but I will do my best. If I do not cover them all, it is not because I have ignored any of the points raised; rather, it is because there were too many good speeches to address in a short space of time.

The hon. Member for Bristol West (Thangam Debbonaire) made some extremely good points. She rightly highlighted the issue of unemployment, and I, too, am particularly concerned about that. We have just published the work and health strategy, and this is an area where we need to do better. The reality is that there is a great skillset here for particular disciplines, and enlightened employers recognise that. We can do a lot more to spread good practice here, as with GP surgeries, such as about what would be sympathetic interview styles for people with autism, so that we can enable them to become integrated. The hon. Lady is right that work is probably the best tool with which to protect our mental health, and we will look at that.

I was also intrigued by the hon. Lady’s autism surgeries, and wonder whether she might consider making that a toolkit that all of us with an interest in the issue could roll out in our own surgeries. Again, a lot of this is about raising awareness of the challenges people with autism face. We are in the public eye and have the ability to do that, so I ask the hon. Lady to tell me how she organised those surgeries.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly mentioned schools. There is a problem with provision, and whether we always get it right—whether it should be mainstream or alternative provision, and whether we have enough places for alternative provision if that is the appropriate setting. That is particularly challenging in my local area, but it is not fair to fail individuals by excluding them because maintaining them in mainstream schools is either challenging or not appropriate for them. The state needs to ensure they get appropriate schooling.

My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) spoke at length about her own experience and set me a number of challenges. I will be happy to report to her on them. I can also give her every guarantee that the data she asked for will be made public next year.

I shall now turn to some of the things we are doing to develop the autism pathway and autism strategy. We have set an expectation in the NHS mandate that the NHS will reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives. We acknowledge, however, that the complexity of autism and the multifaceted nature of the needs of those on the spectrum poses particular challenges to professionals and commissioners. I am keen that mental health should be considered by the new task and finish groups that are being established to implement the autism strategy, and I will ensure that progress is made in implementing the strategy in line with the Autism Act 2009.

It is important that the NHS accommodates the requirements of vulnerable groups such as autistic people through staff training, awareness raising and reasonable adjustments to services, as we have heard. Autistic people should be able to access mental health services like everyone else if they are supported to engage with services and helped to explain their problems so that they can receive treatment. They should not fall between two stools—between autism or learning disabilities services on the one hand and mental health services on the other. We need to ensure that we are giving bespoke treatment and care to people with both issues.

A lot of the treatments that we are developing in mental health will not be suitable for people with autism. We are therefore looking at what we can do to alter the psychological therapies that are available to make them more user-friendly and sympathetic to people with autism. I was horrified to hear what was said about group therapy. I am a lay person, but it is pretty obvious to me that group therapy is not appropriate for people with autism. Clearly, the fact that that is happening is an indication of how much more we have to do to ensure that society is more sensitive to the needs of those people.

I am running out of time, and I really want to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow, but I just want to emphasise that research will play an important role. We are looking at many projects at the moment. There is a research theme on neurodevelopmental disorders, and a project at Avon and Wiltshire Mental Health Partnership NHS Trust looking into guided self-help for depression in adults with autism, as well as work at Leeds and York Partnership NHS Foundation Trust. In the East of England, a project is being led by Professor Simon Baron Cohen focusing on suicide, autism and autistic traits, which will obviously be of interest to everyone who has participated in the debate today. I am grateful, too, for the research undertaken by Autistica, which has really highlighted this issue and brought us to where we are today. I am pleased to say that Autistica has met the national suicide prevention strategy advisory group, which advises the Government on the national suicide prevention strategy, to talk about its research. We will be reflecting on the advice that it has given us.

I thank everyone once again for participating in the debate. As I have said, I am always interested to hear about good practice and what more we can do. Rest assured, we still need to do much more to support people with autism, and particularly to ensure that they can access appropriate mental health services.

Hormone Pregnancy Tests

Madeleine Moon Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

As I have said, I think that I have been very honest about the way in which the families have been handled, about the notice that they have been given and about Members being able to attend report launches. There is no great secrecy here, but I can see how events like that merely feed that notion.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Like the right hon. Member for Broxtowe (Anna Soubry), I am reminded of the contaminated blood inquiry, which is ongoing. In 1975, the regulator knew that there was a potential 5:1 risk of the drug causing deformity. They told the manufacturers but not the patients, and papers were deliberately destroyed by the chief scientist. It is deeply worrying to the families that there is not an open and transparent investigation into this matter. Does the Minister know whether the Berlin archive papers were examined as part of this inquiry, because they demonstrate the cover-up that has happened over many years?

[Steve Brine]

No, I do not. I will write to the hon. Lady about that, but I can tell her that issues relating to the historical regulatory process were outside the scope and remit of this review.

Incontinence

Madeleine Moon Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

Incontinence is not an issue that is often discussed in the Chamber. Society sees the condition as a taboo, which is hidden from public view while sufferers cope in private. However, an estimated 14 million people in all age groups will, at some point in their lives, experience a problem with bladder dysfunction. A further 6.5 million will have bowel dysfunction.

It is generally assumed that incontinence is a condition that affects older people, but that is only half the story. The National Childbirth Trust estimates that almost half of all women experience urinary incontinence after childbirth; there are around 700,000 births a year, so as many as 350,000 women could face this problem. NHS figures suggest as many as 900,000 children and young people experience some form of problem.

More than 300,000 people are diagnosed with ulcerative colitis and Crohn’s, otherwise known as inflammatory bowel disease, and the most common age for diagnosis is between 18 and 30. Those conditions affect the digestive system to different degrees, but one in 10 people will experience regular incontinence. A 2012 survey by Crohn’s and Colitis UK found that 61% of people had not sought medical advice for the incontinence. Like all other conditions that have associated problems with incontinence, that leads to social isolation. Crohn’s and Colitis UK surveyed 1,000 young people on their experience, and 75% said that their condition made socialising impossible because of always needing to know of the proximity to a toilet. On a very simple level, given how many local authorities are closing access to public toilets, is it not time that we looked at alternatives? It is surely not beyond our wit in this House to look at issues such as rate relief, so that hotels, restaurants, pubs and cafes provide access to their toilets for those who urgently need to have it.

[Melanie Onn (Great Grimsby) (Lab)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests. Does my hon. Friend agree that businesses with a high footfall could do an awful lot more to support their customers’ needs in respect of incontinence issues, and consider additional aids such as the Crohn’s and Colitis UK “Can’t Wait” card—a facility to enable individuals who suffer from incontinence issues to access the toilet facilities of businesses that would not ordinarily allow people to use them, but which support their customers as and when they might need it, to avoid any emergency situations?

[Mrs Moon]

I thank my hon. Friend for her work in this area. That most certainly would help, and it is so simple; it is not a huge thing to do. Another example is simply having a shelf in toilets where someone with a colostomy or ileostomy can place the clean bag, so it is readily available while they remove the full bag. That would make things so much easier and healthier, by ensuring there is no cross-infection. Instead, people often have to scrabble on dirty toilet floors, trying to access what they need.

All the figures I have to hand today are estimates—as one patient group pointed out to me, the collection of statistics in this field is patchy at best, and putting a true figure on the scale of the problem is very difficult—but we will not tackle taboos until we start talking about them: we must destigmatise the subject so that no one faces humiliation if they admit to a problem. We need to bring this issue out into the open once and for all, so that people no longer suffer in silence and we can reduce the long-term health implications and additional costs for the NHS.

An analysis of calls to the Bladder and Bowel Foundation’s helpline in 2015 suggested that half the people with a continence problem had never spoken to a healthcare professional. Another study found that only one in three families seek help for children and young people with a continence problem. Imagine the long-term impact on a child’s health of having to try to manage such a problem at school, with all the stigma of being the smelly kid and all the fear of having an accident during a lesson.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this subject forward; it needs to be aired and she is doing that very well today. I thank her for that. Does she agree that young people suffering from ulcerative colitis, Crohn’s disease and other inflammatory bowel diseases need more help and support to deal with the lifestyle changes that these illnesses can bring? The latest statistics show that 75% of those young people say that they cannot have an active social life because of their condition, and I believe that restaurants, shops and councils have a responsibility to do more to help them to lead as normal a life as possible.

[Mrs Moon]

I would ask every Member to consider the impact on their life of suddenly having a desperate, urgent need to access a toilet while at work or walking down the street, and there not being one available. Of course we must do more; no one can assume that incontinence is not coming their way or coming to a member of their family. As a society, we have to take responsibility for ensuring that people can access toilet facilities wherever they are and whenever they need them.

[Dr David Drew (Stroud) (Lab/Co-op)]

My hon. Friend is making a compelling case. She will be aware of ERIC—Education and Resources for Improving Childhood Continence—which has campaigned for many years for better availability of continence pads. These are still charged for at very high rates. If every school were to provide continence pads, a lot of children would have a much better experience at school.

[Mrs Moon]

I thank my hon. Friend for that intervention. In particular, we should look at the need for teachers to understand the issue of incontinence. They need to understand that a child who constantly puts their hand up and says that they need to go to the toilet is not trying to get out of the lesson, and that it is perhaps an indication of a deep-seated problem that needs to be tackled. There is certainly a need to educate and to build awareness of continence problems in schools. This relates to the little ones coming into the reception class—some of whom, increasingly and shockingly, have not been potty-trained and have not learned to control their bowels and bladder—and the problem continues throughout the school. Schools need to step in and ensure that parents and children have access to the help and advice that they need.

People should have the confidence to talk about the problem to GPs and to seek an early diagnosis and intervention. People should not have to assume that it is something they have to live with. It is estimated that people manage the problem themselves for an average of five years before seeking help. We also need to highlight the detrimental impact that incontinence can have on an individual, and the fact that existing policy responses exacerbate the situation. This is a quality-of-life issue. It affects sleep and mental wellbeing, and it can cause isolation. For a child, it can have a long-term impact on their self-esteem and on family relationships, and it often makes them vulnerable to bullying.

Access to toilets can become a determining factor in every journey and activity away from the home. The condition can also lead to more complex health problems, which are inevitably more expensive to treat, and some people even choose residential care so that they can have management of their problem. One specialist in the field summed the situation up by saying:

“The reality is that bladder and bowel continence needs can affect anyone at any age. It can reduce a person’s enjoyment of life, ability to live an independent life, reduce education and work opportunities and lead to further medical complications.”

Patient surveys have highlighted the limitations imposed on people’s lives by their conditions. For sufferers who responded to a survey, those restrictions and sleep deprivation were the worst aspects, with 93% saying that it had affected their mood, 63% saying that it had affected their ability to work, and 39% saying that it had forced them to take time off work. Frustratingly, there are solutions for many, but people all too frequently struggle to cope on their own, using incontinence products available in local chemists rather than seeking the help that could be available from the NHS.

[Rosie Cooper (West Lancashire) (Lab)]

It is really important to note that people who rely on getting pads and looking after themselves are not getting the best service, and doctors and nurses are sadly not receiving training in this most important area. Shockingly, the pre-registration nurse curriculum does not include training for bladder or bowel incontinence, so it is all too easy not to address the real problem. We need that experience to help people; we should not just pad them up. People can be helped with exercise, for example, and there are many interventions that could help instead of them being told simply, “Go and buy a pad.”

[Mrs Moon]

I commend my hon. Friend’s work for the all-party parliamentary group on continence care, which does invaluable work in this area.

I am going to jump to another section of my speech. It is shocking how many people go into hospital with no continence problems but may be incontinent or doubly incontinent and have major problems by the time they leave. It is far too easy for nurses and doctors to see the use of pads as the only solution. At some point, I hope the Minister will look at how we can gather figures from hospitals on how many patients enter with continence problems and how many leave with continence problems to get some idea of how great the problem is.

I chair the all-party parliamentary group on Parkinson’s, and the Minister will be aware that Parkinson’s UK has campaigned for many years due to the problems that people with Parkinson’s have when they go into hospital and their carefully timed medication regime is changed to fit in with drugs rounds on the ward. A perfectly mobile and continent person can become immobile and incontinent due to NHS failure. That cannot be allowed to carry on. It is shameful that we are facing such problems in 2017.

Diagnoses are not made in a huge number of cases. Healthcare professionals do not provide consistent assessments, diagnosis and follow-through according to standard practice. Even basic things, such as an assessments of where the toilet is in relation to where someone sleeps, are not carried out by social workers. I cannot begin to tell the House how many times people are admitted to hospital as the result of a fall at night caused by them trying to negotiate the stairs to go up or down to a toilet that is on a different level from where they sleep. It is shocking that people face having to wear an incontinence pad because they cannot use the stairs or because there is a risk of them falling at night when accessing the toilet. We simply must get this sorted out.

Incontinence can cause additional problems. Urinary tract infections, pressure sores, anxiety, depression and falls cost the NHS a great deal of money, and we could save money by making relatively simple changes. I have not been able to find any comprehensive analysis of the cost to the NHS and other services that would demonstrate potential savings from early interventions. As far as I am aware, such an assessment has not been carried out. A series of parliamentary questions tabled last year revealed that data are not held by the Department of Health on the number of people admitted to hospital for catheter-associated urinary tract infections, for non-catheter-associated urinary tract infections or with urinary incontinence generally. If it existed, such information would help to clarify the extent of the problem. An estimate was offered in 2014-15, with NHS trusts reporting an annual cost of £27.6 million, which is almost certainly an underestimate.

Too many individuals are bearing the brunt of managing their condition. Buying a regular supply of pads costs anywhere between 10p a pad, for a child, and 60p a pad, depending on the type of pad required.

[Melanie Onn]

My hon. Friend is being generous with her time. Does she think that now is the time for the Government to reconsider the VAT on these products?

[Mrs Moon]

We need to reconsider the issue of VAT on a whole range of sanitary and continence products. As a society, we need to take responsibility for the facts of our daily life. For a person on any sort of restricted income, such as those on benefits, the costs even of simple laundry are huge when dealing with incontinence.

Some families are spending up to £100 a week buying incontinence products. It is ludicrous if they are not able to access those products through the health service or joint stores with local authorities. It is a postcode lottery whether or not a person can access the help and support they need, which is shocking. Think of the savings in sickness pay, in hours of work lost and in mental health and wellbeing if we started to tackle this problem.

It is time to raise a number of issues, including what happens when things go wrong.

[Jim Shannon]

The hon. Lady has referred to people being caught short and, from my knowledge of people who have come to me with their problems, there is a lack of understanding from employers towards employees who have these problems, with people losing their jobs. Does she agree with me and other Members that there has to be a better understanding from employers of employees who have this problem?

[Mrs Moon]

I recently had a meeting with employers in Bridgend, and the chief executive of CGI was present. That company is proactive in asking its employees what problems they have so that it can support, rather than punish, when those problems affect people’s working situation. People with incontinence should feel confident that they will not lose their job if they say, “Actually, I have this problem. I am going to have to go to the toilet.” Shockingly, I found another employer in my constituency that was making deductions from employees’ wages every time they left the floor to go to the toilet because it was time away from their telephone response service. Yes, we need to consider the whole issue of employment practice in relation to incontinence.

Between 2007 and 2015, 92,000 women in England are thought to have had vaginal mesh implants as a treatment for incontinence. As many as one in 15 women have gone on to have those removed because of complications. The individual testimonies of those affected are dreadful, and while dealing with the wider issue of incontinence we must not forget their plight. I commend the work of my hon. Friend the Member for Pontypridd (Owen Smith), who has brought this issue to the attention of the House, but it is also important that the Government carry out a full audit, establish a registry to determine how many women have been affected, suspend this treatment and look at how we can make sure that the damage and destruction of people’s lives does not continue.

I know you have been generous with our time, Madam Deputy Speaker, as the House has concluded its other business so early, but I hope that the need for action on this has become obvious. First and foremost, we need to work collectively to raise the profile of incontinence as a public health issue, not as a personal failing—that is how it is seen. If I have an incontinence problem, it is seen not as my having a medical problem but as there being something wrong with me. That view needs to be turned around. People need to be able to talk to their GP. If we go into any pharmacy, we see a sign saying. “If you’ve got a cough and it persists, see your GP.” There are signs saying, “If your mole is changing size, talk to your GP.” We need to have something that says, “Suffering incontinence? Well don’t suffer in silence, talk to your GP. You will be able to access help and support.” We need to stop assuming that this is something that affects older people and to engage schools in understanding how it affects young people. We need to educate young people on bowel and bladder health. Why on earth do we not talk about this? Are we really so hung up that we cannot talk to young people about the fact that at some point in their life they may have a problem, tell them what they do about it and say what sort of help they can get?

Will the Minister give us an idea of what his Department plans to do to tackle the huge hidden problem of incontinence in this country? Will he agree to talk to the devolved Administrations so that we do not just set something up for England, but we all take responsibility for this? I am sure that the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Newport East (Jessica Morden) would agree that we must get this sorted once and for all.

When people seek help they need to feel that health professionals will be equipped to help them. It is also important that doctors are trained in this; it needs to be part of the core training of all nurses and doctors. It should also be there for those who are training to be nursery nurses. We need to build that conversation and to do it soon. It is important that the General Medical Council takes responsibility for moving this forward. I am aware that in England the NHS published “Excellence in continence care” in November 2015, which sought to define what best practice should be and to make recommendations. The document was very welcome, but implementation has been slow. The executive summary even commented on that, saying:

“Over the years, some excellent research and guidelines have been produced for best practice continence care but this work has often stalled as it has not translated into a clear commissioning plan for a local continence pathway.”

Will the Minister ensure that every local authority and every health authority has a clear continence pathway? That is not a big ask; they should be doing it already. Can we make sure that such pathways are now in place?

Continence services in the UK vary in quantity and availability, with a report in 2010 concluding that patients were faced with a “life sentence” of suffering due to non-existent or poor diagnosis, a lack of treatment plans and poorly co-ordinated care. Earlier this year, a Paediatric Continence Forum audit established that only 41% of clinical commissioning groups and health boards provide all four main continence services and product provision. That is absolutely shocking.

I hope I have convinced the Minister that he should take the opportunity to make a change in the quality of life for far too many people in this country. This is a problem area that we have neglected for too long.

--- Later in debate ---

[Steve Brine]

I thank the hon. Lady for her intervention. I will take that away with me, and I will come on to the point about the CCGs.

I was just about to outline the approaches that NHS England wants to take to ensure that commissioners are following the framework. They include arranging for CCGs to have access to teams of expert clinicians, commissioners from areas that have adopted the guidelines and are following best practice, and people with lived experience to review their existing service against the best practice and make appropriate improvements. NHS England is also exploring the potential for a mandatory data set to provide transparency about the continence services being commissioned and encouraging CCGs to develop integrated commissioning arrangements to improve co-ordination, experience and use of resources. That is all very positive.

In addition, the National Institute for Health and Care Excellence—or should I say NICE as I am now getting to grips with all the acronyms—has produced a range of guidance for clinicians to support them in the diagnosis, treatment, care and support of people with continence problems, including the 2015 quality standards for urinary tract infection in adults, which sets out how treatment must be holistic.

I understand that the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), recently replied to the hon. Member for Bridgend on the issue of paediatric continence data and the risk of losing the National Child and Maternal Health Intelligence Network, which provides a valuable data resource. Let me take the opportunity to reassure the hon. Lady that the ChiMat legacy website can still be accessed. Paediatric continence is a very important issue. I understand that Public Health England is grateful to the Paediatric Continence Forum for its productive collaboration over the years and that it wishes this relationship to continue. It has agreed that if PHE’s infrastructure remains the best place within the health system to enable these reports and to make the data available at a local level, it will make every effort to recreate the paediatric continence needs assessments during its 2018-19 business planning process. I am the Minister responsible for Public Health England. I see its leaders regularly and I will raise it with them next time I see them.

[Mrs Moon]

rose—

[Steve Brine]

I would also like to use this debate briefly to mention transvaginal mesh implants, which the hon. Lady rightly raised in her speech. She was about to intervene to ask whether I was going to mention them. I know that some women experience severe side effects and complications post operation. I know that there has been considerable interest in this across the House. The hon. Lady mentioned the hon. Member for Pontypridd (Owen Smith) who chaired a working group on it recently and is looking to set up an all-party group on the subject.

I have heard heart-breaking stories and I have talked to colleagues in the House who have been contacted by constituents about this. We have to make sure that we listen, not only to provide the best support but to inform health services so that they can reduce complications from the treatment. When complications do occur, we must ensure that they are treated promptly and effectively.

We must also remember that these procedures help thousands of women each year who are suffering the distressing effects of stress urinary incontinence and pelvic organ prolapse. Surgical procedures using mesh devices have provided an effective form of treatment that can be far less invasive than alternative surgical procedures. Let us not throw the baby out with the bathwater. In 2014, NHS England set up its mesh oversight group which, in partnership with clinicians, regulatory experts and patient groups, published its final report in July this year which helps to address the three major issues highlighted by clinicians and patient interest groups alike: clinical quality, data and informed consent. That answers the point made by the hon. Member for Bridgend about the devolved Administrations. Yes, we liaise with them, and I welcome the news that both Wales and Northern Ireland will be setting up their own working groups. We would like to see more collaboration on this topic across all the devolved Administrations, and we will give them every support so that they can learn from what we have found in the NHS England working group. I hope that that answers that point.

The hon. Lady raised a couple of other issues. She made a really good point about non-domestic rates and public toilets. That issue is raised in the House more often than it should be—it should not need to be raised. I will make sure that my colleagues in the Department for Communities and Local Government hear her call. There is a discretionary relief scheme on non-domestic rates that councils can access, and I am sure that she has made her council aware of it. I encourage other Members to do so, because that is how the discretionary scheme can be used. It is exactly what it says on the tin—it is discretionary.

The hon. Lady made an excellent point about installing a shelf in public toilets. That would be welcome. As a parent of young children in the not too distant past, a shelf would have come in handy on lots of occasions. She made an excellent point about the changing of continence products. The hon. Member for Stroud (Dr Drew) made a point about ERIC. I was not aware of that, so I thank him for doing so and will look it up. He also spoke about the need for teachers to be informed about the subject. I urge him to pursue that with Education Ministers, but I am sure that they have heard tonight’s debate, given that they have been mentioned.

The hon. Member for Bridgend made a really good point about hospital data on continence, access to tertiary care and exit from hospital care. My family and I have experienced the fight on Parkinson’s on far too many occasions. I thank the hon. Lady for the work that she does on the all-party group and I look forward to meeting her in that capacity. I will ask officials to look at the very good point that she has made. She also raised VAT on sanitary and continence products. The Government have taken action on VAT on women’s sanitary products within the realms of what is possible as a member of the European Union. We have invested that money in women’s health charities, as she knows. On the wider point about VAT, we are restricted as a member state, but we will soon be free, and we will be able to make those decisions in the House—taking back control, as someone once said.

Finally, the hon. Member for Strangford (Jim Shannon) made an excellent point about employers and their understanding of the issue. Employers should show every understanding in this area, and I expect them to do so—I do not think that I can be clearer than that.

To conclude, I thank the hon. Member for Bridgend once again for highlighting these issues. For all those who suffer from continence issues, it is important that we talk about the topic, treat it seriously, and work together to overcome the taboo and stigma by speaking candidly about it. I genuinely believe that only by doing so can we truly provide patient-centred services, where patients are at the centre of everything we do. We work with the healthcare professionals, commissioners, providers, pharmacists and trusts to improve the advice and services offered to best meet the needs of the people who rely on and—let us remember—pay for these services.

Question put and agreed to.