Mental Health

Madeleine Moon Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Bradshaw]

My hon. Friend is absolutely right. I hope that the Minister heard her intervention, because I will leave that bit out of my speech. I was going to raise the ongoing problem of the interface between mental health services for young people and adolescents and those for adults. A lot of people are falling through the gap.

There has been a lot of talk, including from the Government, about parity of esteem, but there is scant evidence of it on the ground at a local level. I ask the Minister to explain when he responds to the debate why, if the Government are serious about parity of esteem, NHS England has removed it from this year’s NHS mandate. That is the important document that the NHS publishes every year to tell local health services what they have to deliver. Why has parity of esteem been removed?

Why are the Government cutting so drastically the funding for public health, which delivers many preventive services, such as alcohol and drug treatments and psychological support for young people in schools, that stop people getting ill in the first place, saving money and lives?

As we have heard, after years of falling, the rate of male suicide is on the increase again. Suicide is the main cause of avoidable death among young males.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Would my right hon. Friend like to attend a meeting held by the all-party parliamentary group on suicide and self-harm prevention and the all-party mental health group, at which Dr Robert Colgate will address us on the subject of triaging? By that process, mental health nurses, social workers and GPs can triage a patient for whom they cannot get an immediate appointment and enable appropriate care plans to be put in place while they wait for the next-stage appointment. The meeting is on 29 January, and I hope that my right hon. Friend will join us.

[Mr Bradshaw]

I am sure that hon. Members will be grateful for that public invitation in spite of the pressure on their diaries from numerous all-party parliamentary groups.

Yesterday, the Health Select Committee was told that, whereas the vast majority of acute hospital trusts were expecting to run deficits this year—a big increase— the figure for mental health trusts was much lower. We might think that that is a good thing, but the reason that acute trusts are running such big deficits is that they are giving priority to ensuring safe care. So, if far fewer mental health trusts are running deficits, is that because they are simply cutting services? I should be grateful to hear the Minister’s view on the difference between the deficits being run by mental health trusts and those run being by general acute hospital trusts.

I shall close now, because many people want to speak in the debate. There is probably no one here or outside the House who has not been affected, or whose family has not been affected, by mental illness. We have been hearing warm words from the Government for several years about how things will improve. Indeed, we have heard today that they are improving, but that is not the experience of people on the ground. So I hope that, when the Minister responds, he will focus on action and delivery and not just on words.

--- Later in debate ---

[Simon Danczuk (Rochdale) (Lab)]

It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I am very grateful for this debate, as the issue is very close to my heart. It is vital to ensure that everyone has access to the best mental health services. As the Secretary of State pointed out, one in four of us will face some form of mental illness over the next year, but figures from the mental health charity Mind suggest that 75% of those with anxiety or depression get no treatment at all. It is vital that we start taking mental health more seriously, starting with adequate funding and giving mental health the parity with physical health that it deserves.

I wholeheartedly support a protected NHS budget. The most effective treatment of mental health issues, however, is seen at local level in communities. A protected budget means little when funding to mental health services at local level is being slashed. Those in need reach first for their local services, yet the scale of cuts, particularly to local councils, is having a direct and detrimental effect on services that are crucial to helping many people deal with their mental health problems.

The Royal College of Psychiatrists states that a key part of mental health services is good public health funding, yet only 1% of public health spending is focused on mental health. That will be compounded by the fact that the money given to councils for public health will fall by 3.9%, year on year; that will be an 18% fall by the end of this Parliament. If we are committed to ensuring parity of esteem between mental and physical health, that is simply not good enough.

[Mrs Moon]

My hon. Friend may be aware that last year the all-party group on suicide and self-harm prevention conducted a survey of local authorities to see how many had suicide prevention plans and suicide action groups in place. A large proportion did not have any action plan or any groups working on suicide prevention. Is that not something the Government must address if we are to move forward?

[Simon Danczuk]

My hon. Friend makes a really important intervention on an issue that I was not aware of. The Government should impress on local areas the need to ensure that those things are put in place.

I want to discuss suicide. I pay tribute to the right hon. Member for North Somerset (Dr Fox), who is no longer in his place, for making an excellent speech, not least as regards suicide. It is a particularly important issue in Rochdale, where suicide rates continue to remain above the national average. In our town, the rate is 11.8 per 100,000 people per year; that compares with a rate of 8.9 per 100,000 for England as a whole. The male suicide rate in Rochdale is 18.6 per 100,000, which dwarfs the 14.1 per 100,000 for England as a whole. Those figures show a large rise from 2010, when they were 14.7 in Rochdale and 13.3 in England. Put simply, more people are killing themselves in Rochdale.

Our council, like many others up and down the country, is faced with daunting cuts to its budget. The result in Rochdale is that the council is considering removing funding to the tune of just £20,000 for the award-winning Growth Project. This project works to provide a safe and supportive haven to those with mental health issues on a number of allotments. The work done by the Growth Project has a proven track record of improving individuals’ wellbeing. It promotes good mental and physical health through outdoor activity in a green environment, and participants can literally see the fruits of their labour. To date, the project has 88 beneficiaries, and it embodies the essence of equality for mental and physical health. Although the project is run by a voluntary organisation, fighting mental health issues must not be seen as an act of charity; it is about justice and necessity.

If we are truly to achieve parity of esteem for mental and physical health, it is exactly projects such as the Growth Project in my constituency that will need funding. They do not need to be cut because of pressure on council budgets.

Male Suicide and International Men’s Day

Madeleine Moon Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I very much agree. I hope that this will be part of a move towards a day when men’s issues are treated in this House as being as important as female issues. If that is what my hon. Friend is saying, I am all for it, and I hope that this debate helps us move towards that.

The motion that we are debating today, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) pointed out, specifically mentions male suicide. I want to deal with that subject in particular, as suicide is desperately sad and it is clear that more men than women take their own life each year. In fact, the figures show that around three quarters of all people who commit suicide are men. I would like to place on record the fact that although men are more likely than women to commit suicide, those left behind grieving will be of both sexes and often children.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Can I point out to everyone in the room, please, that no one in this country has committed suicide since 1961, when suicide was no longer a crime? People “commit” murder, burglary or arson, but they do not “commit” suicide. They take their own life, but they do not “commit” suicide—“commit” is a word that relates to a crime, and suicide is not a crime.

[Philip Davies]

I am grateful to the hon. Lady for picking me up again. The terminology may be important to some people, but if I am going to be chastised for using the word that, as far as I can see, is used by every member of the public whenever they discuss this issue, I do apologise. But let us not get bogged down in politically correct terminology. I would much prefer that we dealt with the issue that I am trying to raise.

[Philip Davies]

I am very grateful to my hon. Friend for that. Let us hope—

[Mrs Moon]

Will the hon. Gentleman give way?

[Philip Davies]

As long as we are going to get on to a serious debate about the issue, I will give way to the hon. Lady. I know that she knows a lot about this issue, and if she wants to make a sensible point, I am very happy to give way to her.

[Mrs Moon]

I only ever make sensible points on the issue of suicide, on which I spend a considerable amount of my time.

I can tell the hon. Gentleman that for many families who have been blighted by suicide, the word “commit” is deeply offensive and causes great distress, because it is part of a feeling of alienation and criminality that enters their family. It is an issue of great sensitivity for them. I am sorry that the hon. Gentleman is rolling his eyes, but that is the reality.

[Philip Davies]

The hon. Lady has made her point. I would prefer that we actually dealt with trying to prevent people from taking their own life, or committing suicide, or whatever term anybody wants to use. The end result is the same and that is perhaps the thing we ought to concentrate on the most, rather than focus on what we call it, which does not necessarily help anybody who is a victim of it.

According to the Office for National Statistics, the number of female suicide victims declined from 10.9 per thousand in 1982 to 5.1 per thousand in 2013, whereas male suicide rates in the UK were much higher and were virtually the same in 2013 as they were in 1982—19 per thousand in 2013 and 20.6 per thousand in 1982. Those statistics sound bad enough, but it is nothing compared to the reality of suicide: according to the House of Commons Library, what that means is that in 2012, more than 4,500 men felt they had no choice but to take their own life. Given that there was an increase in suicides in 2013, the figure for that year is nearly 5,000 men.

In fact, over the last 30 years, according to ONS figures supplied by the House of Commons Library, more than 130,000 men have taken their own life. That is a staggering number: it is a staggering number of people who have needlessly died, and a staggering number of families left behind—parents, spouses, children, friends and colleagues —all of whom have been left grieving and suffering.

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

I am here to speak as the chair of the all-party group on suicide and self-harm prevention. I have spent a considerable amount of time examining the subject and raising its profile within Parliament.

Language does matter—being accurate about suicide and its legal status is incredibly important. If we continue to use the word “commit”, we continue to isolate families who have been bereaved by suicide and make those who take their own lives appear in a different class among those who have died. We continue to criminalise their actions, rather than examine what we can do and what responsibilities we can take to prevent further suicides.

I have talked to and worked with many families and individuals who have been bereaved by suicide, and all of them describe the same response—the isolation that they feel. Usually when a family suffers a bereavement, friends and neighbours are around them offering emotional and practical support. Someone with a family member who takes their own life is often isolated. People do not know what to say or do. Often the family are under police investigation because when there is such a death, the police’s first step is to look at whether that death is, in fact, a murder.

Many families have described to me the absolute shock of being investigated as though they were responsible for the death and may have murdered someone. People do not tend to cross police tape lines where the death has taken place, so they do not go to see the family. Often the police then leave because they have satisfied themselves that it is suicide, but they do not come back and explain to the family, “You are no longer under investigation, and by the way, this is where you might actually get some help and support.” One of the most important things that families need in those first few hours is to know, “What do I do? How do I deal with this?” They need to know how to respond to something that has left them shocked and asking, “Why? Why didn’t I notice? What could I have done to stop this? What did I miss?”

[Lucy Allan]

I thank the hon. Lady for her very important remarks. She is now three minutes into her speech and she has not mentioned International Men’s Day. Is she going to mention male suicide and International Men’s Day?

[Mrs Moon]

As I explained at the beginning of my speech, I am speaking on behalf of the all-party group on suicide and self-harm prevention. I will continue to do so.

We have to look at how we support families, including families of men who die by suicide—I concede that men are three times more likely to die by suicide than women. How do we support families and communities? For those who wish to understand how we can support those families, I recommend the excellent work of Sharon Macdonald at the University of Manchester.

We also have to look at what we are doing on suicide prevention planning in the UK. The all-party group looked at the Government’s suicide prevention plan prior to its implementation and then again following the reorganisation of health in the UK. The result was quite shocking, because the new prevention plan, which was very good in many respects and set out good guidelines, did not require local authorities and health authorities to report back to the Department of Health. We had no overall picture of what was happening across the country, so the all-party group went out and surveyed to find out what was going on.

We found that 30% of local authorities did no suicide audit work at all, so they did not know what was happening. They did not know how many men or women were taking their own life locally. Also, 30% of local authorities did not have a suicide prevention action plan; they were doing nothing to prevent the suicide of men or women across their local authority area. More worryingly, 40% of local authorities did not have a multi-agency suicide prevention group.

It is very important that we recognise that suicide is not the responsibility of one Department. It is not simply the responsibility of the Department of Health. In fact, the most active department in dealing with suicide is often the police. They are involved when people make unsuccessful early attempts. It is more likely that the police will know of someone who is about to take their life or who has been at risk in the past than any other agency.

Most suicides have never been anywhere near our mental health services, and it is important that we know what is happening locally. We need to ensure that local authorities’ multi-agency suicide prevention groups are made up of all agencies, including the local authority, the health agencies, the police and the third sector organisations that are often doing critical work on the ground—I cannot say enough about the fantastic support that we all receive every day from the Samaritans in our constituencies who spend their time tirelessly working with people who are very fragile and at high risk of suicide. Groups such as CALM, which the hon. Member for Shipley (Philip Davies) said has given him so much help ahead of today’s debate, are doing similar work. Those third sector organisations are made up of volunteers, many of whom have been affected by suicide and wish to move services forward so that further deaths can be averted.

It is vital that coroners engage with all their partners to prevent future deaths and to ensure that we are aware of where clusters may be beginning to develop, whether they are clusters within an age group, within an occupational group or within a school or factory. Social contagion is a big risk, and it is another example of why words matter. I have seen newspaper stories saying things such as, “Well, it’s just what we do around here.” If we give permission for suicide to be an acceptable way of dealing with the problems and difficulties of life, there is a risk of social contagion, with other people thinking, “That person was like me. If they can take their own life, I can, too.” That is a huge risk that we need to address. Social contagion is a great risk in closed institutions such as prisons, schools or factories, so we need to be aware of the importance of emotional education and language when people are faced with suicide.

I dread to say it, but the one point on which I agree with the hon. Gentleman is that the emotional education that we give to young men in this country is very poor. No matter how modern and how diverse a society we become, we still seem to educate our children to feel that they have to man up and be strong, and that they cannot talk about emotions. Some organisations, particularly sports organisations, have done fantastic work on suicide prevention.

I also stress the importance of longitudinal research on suicide and self-harm prevention. In the past I was fortunate to work with excellent Health Ministers, the former right hon. Member for Sutton and Cheam, Paul Burstow, and the right hon. Member for North Norfolk (Norman Lamb), who were both very supportive of suicide prevention work. If we are to have longitudinal studies of suicide and self-harm, the researchers dedicated to those subjects need to know that they will have the money to continue and pursue their work so that we have a clear idea of the numbers of deaths and whether those numbers are increasing or decreasing.

Other Members want to speak, so I will make a final comment. The all-party group on suicide and self-harm prevention, in association with the all-party group on mental health, will be having a meeting in February, which I hope the Minister will attend. A psychiatrist from my constituency will be coming up to talk about mental health triaging so that people at risk of mental health crisis can go to any agency, including their social worker or general practitioner, and receive help, advice and support through the triaging system, so that no one leaves being told that there is an appointment in six months’ time. We need to be on top of this. People are dying unnecessarily.

--- Later in debate ---

[Mr David Nuttall (Bury North) (Con)]

I start this afternoon by congratulating my hon. Friend the Member for Shipley (Philip Davies) on securing this historic debate. This is the first time ever that International Men’s Day has been marked by a debate in this Parliament. I also thank my right hon. Friend the Member for Basingstoke (Mrs Miller), as well as the hon. Members for Bridgend (Mrs Moon) and for York Central (Rachael Maskell), for bringing their individual perspectives to this debate.

Under the International Men’s Day heading, the debate gives us an opportunity to consider a range of issues that particularly affect men, but in my opinion none is more worrying than male suicide, so I will restrict my remarks today to that issue. The subject is all too often swept under the carpet. It was said at the outset of this debate that one of the problems facing us today is underachievement by white working-class boys from the north of England. Well, as a white working-class lad from the north of England, I am very proud to take part in this debate. Indeed, as a member of the Backbench Business Committee, I was pleased to play a very small part in granting this debate.

I listened with interest to the comments about why the debate is being held here in Westminster Hall rather than on the Floor of the House. However, as right hon. and hon. Members will be aware from the Order Paper, two debates have been scheduled for the Floor of the House this afternoon, one on the forthcoming Paris conference on climate change and the other on the new cancer strategy. It was felt that those debates needed to take place on the Floor of the House. Personally, I would have liked to see this debate take place on the Floor of the House as well, but we are where we are. It was also felt that we should try to hold this debate on International Men’s Day itself if at all possible, which is what we have achieved today.

As I say, I will try to restrict my remarks to the subject of male suicide. It is a subject that no one really wants to talk about.

[Mrs Moon]

To illustrate how important this debate is, let me tell the House that the first piece of evidence from professionals that the all-party group on suicide and self-harm prevention took was from a suicide prevention worker in London, who was also a mental health worker, and he said, “If I call a meeting to discuss mental health problems, I can fill a room. If I call a meeting to discuss suicide, I am there on my own.” That says everything. I thank everyone who is here today to take part in this debate for generating the conversation that is so vital.

[Mr Nuttall]

I am very grateful for that intervention, because that vignette highlights a lot of the problems. The mere fact that we are holding this debate—it may not be in the main Chamber, but it is here in Westminster Hall—and are able to discuss the subject will hopefully generate some wider debate outside Parliament. It might make it just that little bit easier for the debate to take place in wider society.

As I was saying, I approached the debate today with some trepidation, because, as has just been amply demonstrated by the hon. Lady, who is chair of the all-party group on suicide and self-harm prevention, many organisations and people seem to be looking at this problem—governmental bodies, other public sector bodies, charities in the independent sector and academics—and all have greater experience than I have, but I have looked at it with fresh eyes. Part of the reason why I am here today is that I am staggered by the intransigence of the problem. Clearly, there are many people looking at it, but the reality is that the number of male suicides has remained pretty stubborn over decades. This is not a party political point. It does not matter whether there was a Conservative Government under Mrs Thatcher or a Labour Government under Mr Blair; the numbers for male suicide have stayed pretty much the same. That made me think that there is something serious going on here that is wider than just the typical argument about party politics.

I pay tribute to the charity CALM—the Campaign Against Living Miserably—because it has provided some helpful briefing and figures for this afternoon’s debate. CALM says that in 2014 more than three quarters —76%—of suicides were men. That is 4,623 deaths. It is worth repeating that suicide is the biggest single killer of men under the age of 45. For deaths registered in 2013, the last year for which the Office for National Statistics has figures, my own region—the north-west of England, in which my constituency is situated—had a male suicide rate of 21.2. That is the second highest rate in the country, second only to the north-east. The experts will be aware that the rates are invariably quoted in the statistics as a rate per 100,000 of population, so that is 21 people out of every 100,000. As always with these statistics, there is a host of caveats and technical details that could be explored, but I do not think we should let the minutiae obscure the big picture, which is that while the suicide rate in the north-west among men was 21.2, the rate among females was 6.3. A rate of 21 against a rate of 6 is a big difference indeed.

[Mr Nuttall]

I have heard that statistic twice today, the first time in the Chamber, when the shadow Leader of the House made that point. I do not know whether the statistic is correct, but I am prepared to accept what the hon. Lady and the shadow Leader of the House say. I am sure that of those more than 4,000 deaths, some were gay men and some were young gay men. That may well be one of the contributing factors.

The charity CALM has set out four areas where it thinks action should be taken. First, and quite understandably, it states that there is a need for timely and accurate information. That could be applied to many things across Government. It always amazes me how long it takes for what, on the face of it, are fairly simply statistics to be collated and reach the public domain. Secondly, and again understandably, CALM says that we need to understand the reasons why people take their own life, because there is a strong element of contagion, which the hon. Member for Bridgend mentioned. Thirdly, CALM wants all local authorities to develop and implement a suicide prevention plan, and says that those that do not should be named. Fourthly, it states that if national and local suicide prevention plans are to be effective, there must be some accountability—there is no point having a plan unless something is done if that plan is not adhered to.

It is worth noting that in its own way, CALM has tried to give the issue some publicity through social media and the #BiggerIssues campaign, which is an advertising campaign to draw attention to the fact that as a society we tend to pay an inordinate amount of attention to perhaps relatively trivial topics, such as the weather and the sort of coffee we are drinking, rather than to male suicide, which is a real problem in society. The campaign has created digital posters featuring the hashtag #BiggerIssues, which were posted across the UK. Those posters changed every two hours to reflect the fact that every two hours, a man takes his own life. The campaign was run in association with the men’s grooming brand Lynx, and I think we should pay tribute to whoever it was who took that brave decision to link a men’s grooming product with the campaign. Others perhaps looked at it and thought, “The issue is a bit too touchy for us. We’ll leave that one alone.” Whoever was involved at Lynx, we should publicly thank them for being able to associate their brand with that particular campaign.

I was surprised to find that this phenomenon is not unique to this country. Right across the world and in almost every country, there is the same stark difference in the suicide rates. Lithuania, Russia, Japan, Hungary, Finland—almost everywhere we look, the picture is the same: male suicides considerably outnumber female suicides. Apparently that is not the case in China. I am not an academic; I have not spent time looking into this, but it seems to me there may be something in the fact that in one country, China, it is the other way around that may in years to come offer a solution to the problem.

We are a Parliament with different political parties, and for our own reasons we try to make party political points. When I have previously raised this issue, people immediately say, “Of course, it’s all the Government’s fault. The fact that there are lots of men committing suicide is all your Government’s fault, because you are making cuts to public services and you are cutting the NHS”—which is not true; more money is being spent on the NHS than ever before, so that argument immediately falls. Those arguments are easy to make. It is simple to throw out that it is all the Conservatives’ fault, but as I will demonstrate, the statistics—the facts—from the Office for National Statistics simply do not bear out that argument.

In the 1980s, under the Conservatives, the number of male suicides each year was somewhere between 4,000 and 5,000. It did vary a little bit—it got down as low as 4,066 in 1982 and it went up to 4,370 in 1987—but every year it was between 4,000 and 5,000. Between 1997 and 2010, under the Labour Government, the number of male suicides was somewhere between 4,000 and 5,000. Again, it varied—some years it was down, and some years it was up—but every year it was somewhere between 4,000 and 5,000. What is noticeable is that the gap between male and female suicide rates has been increasing steadily in almost every single year since 1981. At the start of this range of statistics, the male rate was a bit less than double the female rate—about 1.78 male suicides for every female suicide, I think.

[Mrs Moon]

Will the hon. Gentleman give way?

[Mr Nuttall]

I certainly will, but I will come back to my point, because I have not quite finished it.

[Mrs Moon]

This gets terribly technical. If I can explain, suicide is recorded under an international definition. To get the statistics, researchers are often required to go into coroners’ records and read individual narrative verdicts. The records therefore are slightly skewed; they are indicative, rather than totally accurate, because there is a difference between a clear suicide verdict that says that a death was a suicide and a narrative verdict that would need to mention intent. We have a problem with the accuracy of our recording. I thought it was important to clarify that.

[Mr Nuttall]

I am grateful for that. I think I mentioned that there is a host of caveats and technical details. I spent some time looking at the statistics and working out how they had been arrived at. As the hon. Lady rightly says, there are a number of difficult issues for researchers that could skew the figures, but whatever difficulties there might be, they apply equally to males and females and would not affect the overall point that I am making here which is that at the beginning of the 1980s, the difference was about double, and today it is about treble. It has gone from a ratio of about 2:1 to about 3:1 today. I do not think this change can simply be put down to Government policy. It was happening under a Conservative Government and continued to happen for 13 years under Labour Governments.

[Andrew Rosindell in the Chair]

Public Health England, which produces a raft of figures on this subject, states:

“Suicide often comes at the end point of a complex history of risk factors and distressing events.”

With other right hon. and hon. Members this afternoon, I pay tribute to the Samaritans, which is perhaps the best known charity in this field for its work in trying to help and to prevent men and women who are feeling depressed from taking their own life. In its review of 2012, the Samaritans found that men from working-class backgrounds were at a higher risk of suicide. The Samaritans stated that suicidal behaviour results from a complex interaction of numerous factors, including bereavement, divorce, unemployment and the historical culture of masculinity. It is a huge and complex subject. Many people will be grateful that we have highlighted some of the issues involved.

I hope that people who are feeling depressed—there are often many reasons and not just one—feel that they can tell someone about their worries. One thing we can all agree on, from whichever political viewpoint we approach the subject, is that suicide—taking one’s own life—is never the right answer. I hope the debate today will help break down the stigma that prevents many men from seeking the help they need.

A&E Services

Madeleine Moon Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

If the hon. Gentleman is seeking an apology, would he like to apologise for the fact that A&Es in England have missed their waiting time targets for the past 100 weeks? I do not see any trace of an apology or any scintilla of embarrassment on his face.

It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy. First, the declining access to social care and the squeeze on primary care have forced people to turn to A&E in increasing numbers and have also meant an increasing number of admissions that could have been avoided if people had received better care outside hospital. Secondly, the Government wasted £3 billion, at least, on a damaging top-down reorganisation that nobody wanted and nobody voted for, and which was hidden from the electorate. That reorganisation sucked resources from front-line patient care. We know that senior members of the Cabinet believe that the reorganisation was a catastrophic mistake. We know that, in the words of British Medical Association chair Mark Porter,

“the damage done to the NHS has been profound and intense”,

and we know that the reorganisation has not made the NHS more productive or more efficient.

Thirdly, the effect of that wastage has been compounded by the short-sighted cuts to nurse training places at the beginning of the previous Parliament. That means that there are not enough staff working in hospitals—that was a key criticism by the Keogh review. In addition to compromising patient safety and clinical outcomes, this Government’s decision has left trusts over-reliant on expensive agency staff.

[Mrs Madeleine Moon (Bridgend) (Lab)]

When I worked in hospitals and was responsible for arranging community-based discharge, two major problems created a delay in discharge—I hate the expression “bed-blocking” as it is such an insult to elderly people. One was access to community care facilities—home care support—and the other was ensuring that we had community equipment, such as hospital beds, hoists or bathing equipment. If we do not have all the pieces in place, which often come not from NHS funding but from local authority funding, it will not happen. That is exacerbating the problem in A&E.

[Mr Reed]

My hon. Friend makes a prescient point. The Government talk the talk but do not want the walk, and she has detailed precisely why that is the case.

Local Suicide Prevention Plans

Madeleine Moon Excerpts

Wednesday 4th March 2015 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray.

This debate comes after a report by the all-party group on suicide and self-harm prevention, as well as the publication of the most recent suicide statistics two weeks ago. I want to start with a quote from someone who gave evidence to the all-party group. It was the most powerful statement that we received. Speaking on behalf of one of the London authorities, the person said:

“People don’t want to talk about sad subjects…I could get dozens of people in a room for mental health but not suicide…I had maybe four or five people in the room for a suicide meeting, out of an invitation list of dozens who had attended similar events on the subject of mental health.”

There is the problem. People do not want to talk about sad subjects. They do not want to look at suicide. It is too painful and too difficult. They avoid tackling a problem that blights the lives of far too many people in this country.

The all-party group requested information from all 152 local authorities in England. Eventually, after some poking with a sharp stick and freedom of information requests, all but two replied. The data revealed a shocking lack of understanding of the basic difference between suicide and mental health. Some people think that if someone is suicidal, surely they have a mental health problem, but it depends on the definition of mental health. They almost certainly will not have a classified mental illness. It is generally acknowledged that three quarters of people who take their own life have never been near mental health services. It would be wrong to assume a close working correlation—that if someone is working to prevent mental health problems, they are helping to prevent suicide.

The most worrying finding of all was that a third of local authorities in England had no suicide prevention action plan whatever. A third did not undertake suicide audit work, and 40% had no multi-agency suicide prevention group. That is totally unacceptable. Mr Gray, you and I have spent some time over the past couple of months looking at the importance of having a strategic plan and knowing what one is trying to achieve and the required outcomes. Across England, a third of local authorities have no strategy—nothing at all. They are doing nothing to prevent preventable deaths, and 40% have no multi-agency suicide prevention group.

This does not require big money. It is not about expensive drugs. It is about putting time and effort into looking at what the problem is locally and how it can be tackled, and then pulling together the agencies that can work together to deliver a plan. That does not seem too big an ask to prevent an avoidable death, yet for a third of local authorities in England it is too big an ask. That is shocking. I hope that the Minister will approach those local authorities and say, “Things need to be better”. All Members whose local authorities do not have such a plan and action group ought to be proactively telling them that they are wrong.

[Jessica Morden (Newport East) (Lab)]

I commend my hon. Friend and the all-party group for their work on this issue. She speaks with great authority about the data for England, but what is her understanding of the situation in Wales?

--- Later in debate ---

[Mrs Moon]

I thank my hon. Friend for her question. We are both Welsh MPs, and we know how dire the situation is in Wales. The suicide rate in Wales is 15.6 deaths per 100,000—the highest in the UK. That is perhaps part of what drives me. I know that we have our own problems in Wales, but the matter is devolved to the Welsh Assembly. The all-party group’s work helps to highlight the problems here in England. After Wales, Scotland has the next highest rate, followed by Northern Ireland and the north-east of England. There is a serious problem in Wales that we must tackle as well.

People cannot be complacent if their area has a low level of suicide, because facts change, deaths change, and the figures change. At one point, the Isle of Wight had a very low suicide rate, but now it is higher, and it is considered to have an average rate. It has gone from low to average—that is a rise. We cannot assume that because the suicide rate is currently low it will remain that way.

The report highlighted particular concerns about London. It shows poor levels of suicide prevention planning, but also low levels of deaths. That does not make sense: not only the lack of action planning, but everything about the demographic profile of London and some of its regions would suggest that normally there would be a higher level of deaths in certain local authorities. Something must be done to examine what is happening, because either the data are wrong, and what is really happening is being hidden, or something very special is happening in London that provides some sort of insulation against suicide. We need to understand that. The age-standardised rate of death in London is 7.9 per 100,000, compared with Wales’s rate of 15.6. The gap is huge and must be addressed.

The most active local authorities and those with the highest rates of death from suicide in England are in the north-east, the south-west and the north-west, areas of social deprivation and high unemployment, and where the so-called economic recovery is not being felt. In those areas, the all-persons rates of death are 13.8, 12.5 and 12.3 respectively. On the whole, local authorities in those parts of the country are active, and the report commended their work. However, that raises new questions. We must look at what those active local authorities are actually doing and how they are spending their time and effort. The importance of local initiatives, local focus and local understanding in suicide prevention is recognised—we need to know the terrain, the population and where the pressure points are—but we must also examine the variation in what is being done across England without apparent consistent reasons for the strategic choices that are made.

For example, in some areas, funding is put into helplines, such as the Samaritans and the Campaign Against Living Miserably—CALM. In others, it is put into training, such as applied suicide intervention skills training—ASIST—and in some into better data collection, such as on self-harm, which the Minister and I have discussed often. Other activities will have gone unreported. With wide variability and without clear indication of the evidence on which the various initiatives are based, however, there are questions about which of those initiatives are more effective and why. We need to be able to understand how our suicide prevention work is working and the best way for local authorities to focus their attentions.

The all-party group concluded that both Public Health England and the national suicide prevention strategy advisory group should examine ways in which local authorities can share information about suicide prevention initiatives that have worked, in order to develop best practice. In addition, central funding of research and evaluation studies into the methodologies used is necessary, so that we can drill down to what is effective and why. In that way we can realistically make a difference with any necessary changes even at a time of economic austerity.

The Minister and I have talked about the importance of suicide audits and of timely information, so that people are not waiting for retrospective information to see if a problem is developing locally. Some authorities have a complete lack of clarity about audit work and that needs to be tackled. Much can be dealt with through better co-ordination with coroners and the provision of timely information by them, but I appreciate that the Minister might have difficulties with that, because coroners fall within the purview of the Ministry of Justice, which is perhaps less focused on the timeliness of information from coroners to help suicide prevention work. That is something that I hope the all-party group will come back to in the next Parliament, because the situation cannot be allowed to continue.

The rate of suicide in this country has generally been on the rise since 2008. Last year the number of people taking their own life increased by 4%. Suicide remains the leading cause of death for men aged between 20 and 34. Last year, 6,233 people in England and Wales died by suicide, which you could describe as a small number—

[Mr James Gray (in the Chair)]

indicated dissent.

[Mrs Moon]

You would not—I am glad to hear that, Mr Gray, thank you.

Each death by suicide is estimated to have an economic impact of around £l million. The reverberations across communities, families and workplaces are devastating. The suicide rate is a key indicator for the health and well-being of our country, our communities and our way of life. Suicide is not some niche issue that can be ignored by a local authority in its public health role because the numbers are too small. The issue is critical and indicates how healthy and how vibrant our communities and our society are.

The debate is probably the last about suicide in this Parliament, so I want to take the opportunity to make a few final remarks. The Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), have been active in support of the all-party group and in suicide prevention work. I thank them for their support and acknowledge their work. Despite the failure of local authorities, active third-sector groups such as the Samaritans and individuals touched by suicide have offered support to those struggling to cope with life and to bereaved families. Sports figures and other celebrities have stepped forward to talk about their personal struggles and things that have changed their lives.

The police and other front-line workers are trying to save lives and responding to desperate people on a daily basis. During this Parliament, the role of the police in particular in tackling mental health problems, suicide, missing children and a whole range of other social problems outside their normal crime reduction role has shown their leadership and initiative. The work that the police are now undertaking to draw up a national process for responding to suicide is particularly welcome.

Suicide has not been illegal in this country since 1961, but it continues to carry a stigma, which we need to tackle. We also need to give support to bereaved families; to provide access to services that offer hope and a future for the suicidal; research in order to identify risks, best practice and awareness training that can prevent needless deaths; and local authorities to accept their responsibilities to support the dedicated individuals who already work across the four nations to prevent suicide. Without such individuals, the figures from two weeks ago would have been so much worse. It is time for us to take suicide seriously.

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Gray, I think for the first time. I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate and, more importantly, on her leadership on the subject of suicide prevention. Nothing could be more important, and any conversation with those going through bereavement following the death of a loved one through suicide makes us realise just how important it is for us to do better. The impact on those people’s lives is massive—the reverberations that she talked about are enormous. We can talk about the cold economic facts and the cost of £1 million per suicide, but the reverberations and economic impact on the whole family and beyond are incalculable.

The hon. Lady also made a point about the suicide rate varying so much around the country, and said that in some areas it appears to be remarkably low. One of the issues that she and I have talked about is whether suicides are being accurately recorded in inquests. We have a completely shared view on the need, once and for all, to confront the issue of the burden of proof, which is an example of the continuing stigma on suicide. To secure a suicide verdict, it remains necessary to prove the suicide “beyond reasonable doubt”; the only other type of death in which that level of proof applies is unlawful killing. That harks back to when suicide was a criminal offence. It is high time that was changed. I have argued the case in government and will continue to do so—whether in or out of government—in the next Parliament, because the change has to happen.

I congratulate the all-party group on suicide and self-harm prevention on its work, and from the start I want to pick up on the role of the police. In my work on mental health, I have been impressed by some inspiring leadership in police forces across the country. In London, the Metropolitan police have worked brilliantly with mental health trusts. In many areas, police are taking the lead in ending the scandal of people being put into police cells in the middle of a mental health crisis. I applaud them.

[Mrs Moon]

The British Transport police have undertaken some particularly successful work in conjunction with the Samaritans on preventing deaths on the railway. That, too, should be recognised.

Child and Adolescent Mental Health Services

Madeleine Moon Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

We want to try to ensure that when there is a crisis, a bed is available locally. With regard to the philosophy of seeking to reduce the tendency to have long periods of in-patient care—institutionalising people—it is absolutely right that we move away from that and focus far more on early intervention, community support and recovery. That is the general trend in progressive views within mental health. However, there must be a bed available when a crisis occurs.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The Minister generously attended the launch of the report by the all-party group on suicide and self-harm prevention, which showed that one third of local authorities have no suicide prevention plan. Has he found any correlation between the lack of such a plan, poor CAMHS provision and a high incidence of suicide, particularly among young men?

[Norman Lamb]

May I first pay tribute to the hon. Lady for her inspiring work on suicide? Not many people in the House focus on issues that are talked about so seldom, so I pay tribute to her for the brilliant leadership she has shown. The all-party group’s report provides some really interesting and important questions of the sort that she has put to me today. These are questions that we need to ask. We have not yet established that link, but I think that it enables us to start asking local areas those questions. The Deputy Prime Minister has talked about the ambition of avoiding every suicide. We can improve services across the board by focusing much more on preventing conditions deteriorating to the point where someone becomes so desperate that they choose to take their own life.

NHS (Five Year Forward View)

Madeleine Moon Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

Of course, that has been a huge problem for Sherwood Forest Hospitals NHS Foundation Trust. I have met the chief executive, who is doing a very good job in turning around the trust, but there are huge challenges. What doctors and nurses in failing hospitals or hospitals in special measures want to know is that they have a Government with a long-term commitment to the NHS and who will deliver the economy that can fund the NHS. They also want to know that they have a Government who will tell the truth about problems so that they get sorted out, which never used to happen before.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Last week, as chair of the all-party group on motor neurone disease, I took evidence from professionals and patients who had been promised that £14 million would be available for communication support from April this year. Not a penny has been spent yet on equipment or new staff. I took phone calls from people who are end-stage kidney diseased who are frightened by the announcement that kidney dialysis is to go from NHS England to clinical commissioning groups. Will the Secretary of State get a grip, make sure that the money that is there is spent, and stop the disastrous move of kidney dialysis to CCGs, which are not functioning?

[Mr Hunt]

With the greatest respect to the hon. Lady, I will very happily look into the concerns she raises, but what we are talking about today is more money going into the NHS because the Government got a grip of public finances and got the economy growing. That means more money for people with long-term conditions, including people with motor neurone disease. The hon. Lady should therefore welcome today’s announcement.

Mitochondrial Replacement (Public Safety)

Madeleine Moon Excerpts

Monday 1st September 2014 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

I rise to speak only on behalf of my constituent Margaret Evans. Margaret was unfortunately forced to move into Picton Court care home in my constituency. I was contacted by her sisters, Val Thomas and Mrs Pitt, who live in the constituency of my hon. Friend the Member for Ogmore (Huw Irranca-Davies), who asked me to meet Margaret to see how mitochondrial disease affects their family. They talked to me about four generations of women who have suffered massive disfigurements. Often they are unable to move their heads because of huge growths in their necks, which require surgery to remove them. Often they are unable to move limbs because the limbs give way and the energy is not there to do so. Breathing can be difficult. The human cost, the human suffering, the disfigurement they experience is horrific.

What affected me most was Margaret Evans telling me that her young daughter, aged seven, is already saying, “Mum, will I end up like that? Am I going to have to suffer this? Will this happen to me?” No child should have to ask such questions when we in this House have the opportunity to change their future to one that will not include suffering, pain and disfigurement. I urge that we move this forward. Let us make a decision. Let us be brave. Let us give an opportunity, a chance of hope, to these families.

Oral Answers to Questions

Madeleine Moon Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

We had a very good round table discussion about this with leaders from around the country last week. What emerged is that fantastic progress is being made in many places, but it is not uniform. There needs to be a concerted effort to ensure that mothers get access to the same specialist treatment wherever they live across the country, and we are determined to achieve that.

[Mrs Madeleine Moon (Bridgend) (Lab)]

21. The all-party group on suicide prevention has been looking at the money going into suicide prevention as a result of the Government’s suicide prevention plan. It is acknowledged by most local authorities that there is more money for mental health, but suicide has been rolled into mental health and there is a distinct lack of support for those who are suicidal but do not have a diagnosable mental health problem. What does the Minister intend to do about that?

[Norman Lamb]

The hon. Lady raises an important point, which she and I have discussed before: the fact that very many people who end up taking up their own lives have had no contact at all with statutory services. I would be happy to discuss further with her what additional steps we can take to ensure that those people get the support they need.

Organ Transplants

Madeleine Moon Excerpts

Tuesday 8th July 2014 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I well remember watching the television as a child in 1967, hearing the news of Dr Christiaan Barnard’s first heart transplant and being absolutely amazed. It seemed like something out of a science fiction book, yet we have moved in a relatively short space of time so much further forward. The one area, however, where we have not moved forward is public recognition of the essential part they have to play in donating a life. We have to raise awareness of that and of transplantation’s possibility and viability. Government and surgeons can only do so much; the public are the vital missing component.

We have, as has been said, a large percentage of public buy-in to the concept of transplantation. Some 97% agree with it, but only 30% carry donor cards. I follow the hon. Member for Montgomeryshire (Glyn Davies), and he and I co-chair the all-party kidney group. That statistic is important, since those awaiting a kidney are the largest group of people requiring a transplant. Some 5,640 people are awaiting transplants. Since April this year, 457 people have received kidneys from deceased donors and 158 have received kidneys from living donors. Those who are still waiting and their families and friends are deeply worried that a donor will not be found in time. In the meantime, they face kidney dialysis, which is a lifesaving but traumatic event. For many, it happens three or four times a week, and their life is on hold.

I disagree with the hon. Gentleman on the initiative taking place in Wales. People frequently say things are half the size of Wales or have twice the population of Wales. We are always used as a measure, but I have long felt that we are a nation of 3 million people that has huge potential for trying new ideas and huge opportunities for breaking new ground. In Wales, 56 people were donors in 2012-13, enabling 211 organ transplants to take place. Some 200 people are on the waiting list in Wales. We have to look at anything that makes a difference. We are a small country and we have to be creative.

The Human Transplantation (Wales) Act 2013 comes into effect on 1 December 2015. Will it make a difference? It provides an opportunity to learn a lesson, not just for Wales, but for the whole of the United Kingdom and, hopefully, the whole European Union and the whole world. I held a debate in Archbishop McGrath, which is one of my local Catholic schools, and the students chose the subject. They wanted to debate it. As young people, they felt that the issue affected them. What was interesting was that over and over again, issues came up where we have to be up front politically and enter into the debate. There was a fear about harvesting and people being allowed to die because surgeons wanted their organs. They were shocked to find, when they did their research, that in reality someone has to die to be an organ donor, in the right way, at the right pace and in the right place at the right time. The best place to be an organ donor—or the worst place, depending how one looks at it—is a high dependency unit, because there is an idea of when someone will die and there can be time to find the person who needs to receive the organs, an available surgeon and an operating theatre.

I reiterate the issues raised by my hon. Friend the Member for Bristol East (Kerry McCarthy) on psychological preparedness, which we do not highlight enough. There is huge stress and strain on people waiting for an organ. Sometimes, when the day arrives, they cannot face it. They feel terror at the change in their life. People have minutes in which to respond, and we should not underestimate how traumatic that can be, or how traumatic survivor guilt can be, whether that is for the person who died so they can live or for those still on the waiting list. The person taken off the list has a chance to live, while others were turned down.

I will briefly talk about some constituents. Jean Schofield gave her kidney for her son, Mark, who has now had three transplants. It is not necessarily just one transplant that is needed; some people need a lot more. Her fear and anxiety over her son has made her a driven fundraiser. She is an absolutely amazing example of how people can give their energies to organ donation and to fundraising for research and support for those who suffer.

Katy Lloyd, who is 24 and from Bridgend, has cystic fibrosis, which was identified when she was four months old. I cannot begin to understand what her family must have lived with knowing that she would eventually need a double lung transplant. The tension and fear experienced by her parents every time she had a cold or fell ill must have been horrific. Following her transplant, Katy said, “I didn’t think about it. It was all I’d ever known.” Imagine if all you had ever known was that one day you would need to face such an operation and that your life was on hold. She has made a fantastic recovery and is a great example of the difference that an organ transplant can make.

Judith French, a great friend of mine, has polycystic kidney disease. Polycystic kidneys cannot be removed during transplants and continue to grow. She was unable to leave the house and had a frequent, urgent need to be near a bathroom. The transplant was wonderful, but she still has large and growing polycystic kidneys, which is like carrying around a big bag of potatoes. She has high blood pressure, a swollen stomach and back problems, but she was refused access to benefits because she had had her transplant. We must consider how the benefits system recognises that transplants do not necessarily end the difficulties that some patients face and that they may still need support.

Andy Eddy, whom I recently met at an all-party group meeting, is 48 and married with two children aged 11 and 13. He was a practising solicitor and was advised to have a hepatitis C injection. An unknown genetic defect meant that the inoculation—a positive step to protect his health—actually led to the destruction of his liver. He had liver disease and liver failure and faced a long, horrific wait on the transplant list while his health declined. His life has been turned around following his transplant. He joined the British transplant games as a volunteer, winning one silver and three bronze medals, and is now chair of Transplant Sport. I have written to the Minister about the games, because they should be held at the same time as national transplant week, because they help to show the difference that can be made by a donation. Someone can be taken from death’s door to athlete. That is how big the change can be and that is what we must ensure that people understand.

Finally, it is vital that we get the message out about the need for conversations about one’s wish to be a donor. Talk to your family today about what you want. My husband has a motor neurone condition called Pick’s disease and I have power of attorney over his health. We went to see a consultant, who asked me, “On death, would you be willing for your husband’s brain to be donated for medical research?” I can still feel the shock at being asked that question. I said, “My husband still has the capability to make that decision. I want him to make it.” He said, “I want to do it.” I cannot imagine having that conversation at the point of his death. Such conversations must happen now while people are fit and healthy and they must be stark and serious. That is what I want to come out of today’s debate. I want families around Britain to be having those conversations, so we do not get refusals when people are carrying donor cards.

Care Homes

Madeleine Moon Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I am certainly happy to have another look at the White Paper and to discuss it with my right hon. Friend, but let me just address his key point. It is absolutely right to say that when we have closed doors, awful things can happen beyond the sight of the public. Professor Martin Green, who is a very good leader of providers of care, has argued the case for care homes to become a sort of hub in their local community, opening their doors to ensure that they become a centre of excellence for that community and providing services and support for people who may live independently at home, but who would benefit from the skills in such an organisation. Openness, transparency and ensuring that the public gaze is cast upon what goes in such places is the right way forward.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Before I came into the House, I worked for the Care Standards Inspectorate for Wales, and when I had concerns about a care home with which I was working, I made unannounced inspections. Will the Minister tell us how many unannounced inspections were made at Oban House, and can he guarantee that the CQC has enough inspectors and enough capacity to carry out frequent unannounced inspections for homes about which it has any concerns?

[Norman Lamb]

We are making absolutely sure that the Care Quality Commission has the capacity and the funding to do its job properly. That question was also asked by the shadow Minister, and I apologise for not responding on that point. We absolutely want to make sure that the CQC has the capacity to do unannounced inspections, but, critically, to do much more robust inspections as well.

This is a process—we cannot introduce a different system overnight—but the new system of robust inspections is already being used in about 1% of care homes, with a view to the process being rolled out fully in October this year. The first ratings of care homes will emerge in October this year. Members of the public, when they are making crucial decisions about where a loved one will receive care, will therefore have much more information about which care providers are good and which are not up to standard. I will make sure that the hon. Lady receives the same timeline of what the Care Quality Commission did that I offered to the shadow Minister.