Care Bill [Lords]

Madeleine Moon Excerpts

Monday 10th March 2014 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.

New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.

The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.

New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.

The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.

A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.

My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Because of the local government cuts, people are no longer thinking about that general duty of well-being. What is almost a “something is better than nothing” attitude has crept in and replaced concern for the well-being and care of the individual, who should be receiving quality care.

[Mrs Lewell-Buck]

I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.

Care Bill [Lords]

Madeleine Moon Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

No, I want to make some progress.

I described the care system we have in England. Surely we can do better. In the last Parliament, the previous Government began a serious attempt at reform. I give this Government credit for continuing some of that work. The Bill contains many proposals originally put forward in my White Paper “Building the National Care Service”, published in February 2010. What most people will remember from the pre-election period was the clash between the parties on funding solutions, but what they might not have realised is that beneath the rhetoric there was much common ground on other matters. I hope that people will welcome that, just as we welcome some of the measures that are carried forward into the Bill.

First, stronger legal rights and recognition for carers are well overdue. For far too long, informal and family carers have been invisible to the system and taken for granted. That simply cannot go on. If statutory services are to be sustainable in the 21st century, they must learn to value informal care and carers and help them do more to help their loved ones. Secondly, we welcome efforts to simplify the social care system. Better information and advice will make a difference to some people. Unifying social care legislation in line with the recommendations of the Law Commission review initiated under the previous Government is sensible and overdue. Thirdly, the idea of a cap on the overall costs of care that individuals can face establishes the important principle that people should not lose everything they have worked for because of their vulnerability in later life.

I am happy to say that those are all important steps forward that we would not seek to oppose. However, let me be clear—this answers the points raised by Government Members—that this Bill is not equal to the scale and the urgency of the care crisis in England. It fails to implement the Dilnot report and does not provide a lasting solution. It does little or nothing to improve care services now or to reduce the costs of care for most people; in fact, it is likely to make things even worse. That is why we have tabled a reasoned amendment to draw the House’s attention to two major problems with the Government’s approach. First, prioritising funding a cap over and above protecting existing council budgets means that the care system will continue to go backwards and get worse, not better. In short, the Government are promising future help instead of helping people right now. Secondly, the proposed £72,000 cap is not what it seems; it is a care con.

On funding priorities, the Government are failing to face up to the scale of the funding crisis facing councils right now. In the cross-party talks on the Dilnot report, Labour stated a clear principle that the cap and the council baseline must be considered together as equal priorities. That was supported by Andrew Dilnot himself, as the right hon. Member for Sutton and Cheam (Paul Burstow) may remember, because he was also party to those talks. As a first step, we called on the Government to use some of last year’s NHS underspend to tackle the care crisis—and, by extension, to ease pressure on A and E—instead of handing the money back to the Treasury. The Government have not listened to that, and this Bill makes matters worse for local authorities by placing new, unfunded and uncosted burdens on them. The fact that it restricts the eligibility of those in substantial or critical need of support is, in itself, a clear admission on the Government’s part that the support system overall is being scaled back.

[Mrs Madeleine Moon (Bridgend) (Lab)]

I spent 30 years making assessments of people who were in care and addressing the care that they needed, often while working in hospitals to get them discharged. After 30 years, the same problem exists: there is not enough money in local government to pay for the care to get people home early to have the rehabilitation they need at home, with the quality of care to make sure that they do not deteriorate further and end up back in the hospital system. This Bill will not tackle that fundamental underlying problem.

[Andy Burnham]

My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.

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[Andy Burnham]

I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.

[Mrs Moon]

Will my right hon. Friend give way?

[Andy Burnham]

I will make some progress and turn to part 2 of the Bill and measures related to the NHS. It would help to get a few facts clear. The Secretary of State seeks to denigrate Labour’s record at every opportunity, but let me remind him that the Labour party left an NHS rebuilt with the lowest ever waiting lists and highest ever public satisfaction. The previous Labour Government introduced independent regulation of NHS hospitals for the first time, prompted by previous scandals at Bristol, Alder Hey and the Shipman murders. The Secretary of State should cast his mind back a little further before coming to the House and making unfounded allegations.

As Robert Francis rightly acknowledged in his report, there was no system of independent regulation before 1997. It was the independent regulator that first uncovered the failings at Mid Staffs and, later, at Basildon. As the party that introduced independent regulation in the NHS, Labour has no problem with strengthening it and providing legislative backing for the appointment of chief inspectors for hospitals, general practice and social care, but let us be clear: those were not recommendations of the Francis report.

The Secretary of State accused us of not supporting the Francis report. We do support the report; it is the Government who are not implementing its recommendations. Just as part 1 of the Bill fails to implement the Dilnot report, part 2 fails to implement the Francis report. One of the report’s central recommendations was for a statutory duty of candour for individuals, but the Government are proposing that it should apply only to organisations. How will an organisational duty help individuals to challenge an organisation where there is a dysfunctional culture? It will not, and we urge Ministers to think again. They also need to clarify whether the duty will cover the most serious incidents, and whether it will apply to all organisations that provide NHS services, including outsourced services.

My main objection to part 2, however, is that it embodies the huge contradiction that now sits at the heart of Government health policy. The Secretary of State talks of independence for the Care Quality Commission in the same way as the Health and Social Care Act supposedly legislated for the independence of the NHS, but this is the Secretary of State who has taken to ringing up hospital chief executives who are not meeting their A and E targets. The Secretary of State nods, but that is not “independence of the NHS”. This is the Secretary of State who holds weekly meetings with the supposedly independent CQC, Monitor and NHS England. What precisely is the Government’s policy on independence? People are becoming confused. Clause 118 makes it clear that the Secretary of State wants more control: he wants sweeping powers to close hospitals without proper consultation and clinical support.

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[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the Bill. I do not propose to follow the shadow Secretary of State into a discussion of competition policy, as there will be plenty of other occasions for that; it is not germane to this Bill. The reason I welcome the Bill is that it begins to look at health and care from a different point of view from the one with which those of us who have participated in health and care debates in this Chamber over a long period are familiar. When a Bill comes before the House, it usually starts off by describing the function of one bit of the bureaucracy—perhaps creating a strategic health authority or re-creating a different bit of the bureaucracy somewhere else on the landscape. This Bill starts in a quite different place.

Clause 1 talks about the “well-being” of individuals and suggests that if we are to build a health and care system that meets the needs of patients and users for the 21st century, we should, instead of thinking of it as a bureaucracy planned from the top down, think about the service that is delivered to individuals who rely on these services. Clause 1 talks about the needs of individuals, and later clauses place an obligation on local authorities to do needs assessments for those individuals.

Clause 2 introduces something that the health and care system has talked about since 1948, but almost never put real resource into, which is preventing the need for the delivery of health and care services, and particularly of acute health care. This Bill’s emphasis is on the needs of individuals and on the need we each feel as individuals to avoid unnecessary health costs and care. None of us wants to be a patient in an intensive care unit if it is avoidable. That is why clause 2 talks about the importance of prevention and avoiding the need for care.

[Mrs Moon]

Does the right hon. Gentleman appreciate that it is possible to carry out lots of needs assessment—goodness knows, I carried out many of them in my day—but that unless care is available to allow a patient to be discharged from hospital, it does not matter how many needs assessments have been done? In fact, the longer patients are in hospital, the greater their needs will be—they will not be able to walk, their incontinence will increase and so forth. What is important is to put the cart before the horse and make sure that the funding of community-based care is there. It is not there at the moment.

[Mr Dorrell]

I shall come on to that point, but to react directly to the hon. Lady’s point, surely it is much better to intervene before the patient arrives in hospital in the first place, preventing the avoidable episode of care. The hon. Lady talks about discharge, and she is, of course, quite right, but how much better is it to prevent the case from arising in the first place, which is what clause 2 is about?

G8 Summit on Dementia

Madeleine Moon Excerpts

Thursday 28th November 2013 Commons Chamber

[Tracey Crouch]

I agree entirely with the hon. Gentleman. We need greater co-operation and collaboration across the world, and if that is needed across the world, we certainly need it at home.

We should recognise that the USA is committed to spending $550 million on dementia research, which is a reflection of the importance of the condition to its society. To be frank, however, the combined investment by the USA and the UK is small fry compared with the investment in research by the pharmaceutical industry. Any collaboration needs to include the global pharma leaders to ensure that they are financing research, bringing together their world-leading scientists and helping to achieve the breakthrough in the prevention and treatment of dementia that we all want. One of the most important outcomes I would like from the G8 summit is a long-term commitment to double investment in research to provide stable and predictable funding so that we can get closer to finding a cure and improved care.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Does the hon. Lady agree that part of the problem is the fact that we use the term “dementia” as if it is just one thing? There are many dementias and we must not focus just on Alzheimer’s. We must be aware of frontotemporal dementias, which affect younger people in particular, and ensure there is funding for research into that.

[Tracey Crouch]

I agree entirely. This is something that blights many conditions, including cancer. We talk about cancer investment, but there is little or no research funding for some cancers. Mesothelioma is a classic example, about which there is a debate on Monday.

It is essential that research focuses on investment in infrastructure. Training and development for researchers is also crucial if we are to see swifter progress towards treatments and cures for dementia. However, it remains hard for an academic with a good idea to spin that off to a company, especially compared with the situation in America. The Government must do more to promote the commercialisation of research as these companies become a vital part of the ecosystem. Large companies and academia can then be partnered in the innovative collaborations that the Government seek.

Research on the provision of care is equally important. Four out of five people with dementia live at home. We want to keep it that way and to ensure that they can live there safely for as long as possible. Research comes in many different forms, including the identification of what works. We know that dementia costs the UK £23 billion, but arguably that money is not being spent properly or efficiently. Prevention is key. Avoiding unnecessary hospital admissions is vital to ensuring that funding is used effectively and, more importantly, makes a huge improvement in quality of life. Researching best practice in care is essential. An economic case developed by the Alzheimer’s Society estimated that if just 5% of admissions to residential care were delayed for one year as a result of dementia-friendly communities, there would be a net saving of £55 million a year across England, Wales and Northern Ireland.

There needs to be a change in the language we use when we talk about care. If we talk about weekly art lessons that are provided to help to improve cognitive function as therapy, rather than an activity, we could hope to see a change in attitude towards research and investment in this area. Many good ideas are having a positive impact in local communities. For example, Medway council, which covers part of my constituency, is promoting telecare as a means of supporting people with dementia, and there are lots of non-clinical treatments that could be further researched, such as the benefits of pets and petting animals for people with dementia, memory rooms and memory boxes. I have even heard of amazing innovative products such as wristbands that monitor someone’s usual actions so that they will detect if they have a fall. We need to consider all those things in the whole pod of research.

We should not forget to consider support for carers. Family carers of people with dementia save the economy £7 billion a year, but evidence shows that they struggle to do that, which can lead to avoidable crises in care, hospital admissions or early entry into care homes, all of which are very costly. The Dementia Action Alliance’s “Carers Call to Action” campaign, which I support, is calling for timely and tailored support for carers, whom I am sure we all agree are an important cog in the wheel of treating and providing for those with dementia.

On best practice, it is important that international collaboration includes the beneficial sharing of successes and failures. In utilising our resources, it is important that we do not duplicate unsuccessful investments and that we champion successful and effective progress. The summit should therefore ensure that all publicly funded dementia research data and results are made available, thereby allowing common factors in national research responses to be shared.

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[Hazel Blears (Salford and Eccles) (Lab)]

It is a great pleasure to follow the hon. Member for Chatham and Aylesford (Tracey Crouch), my colleague on the all-party group. It is also a great pleasure to see you in the Chair, Madam Deputy Speaker. This is my first opportunity to contribute to a debate under your chairmanship, and I would like to congratulate you on your election.

While I am handing out congratulations, I would like to congratulate the Prime Minister, too, on the personal commitment he has shown on dementia. [Interruption.] Credit where it is due. Those who have the presidency of the G8 have an opportunity to name a subject around which they would like to mobilise the international community. In playing his card at the G8, the Prime Minister has chosen dementia. I commend him for taking that action. I believe that international collaboration will be the way to achieve the next big leap forward, particularly on the research agenda. I support what the Prime Minister said at Prime Minister’s questions yesterday—that this issue is not a matter only for world leaders, important though they are; it is a matter for every single person in the community, whether they be a world leader, a health Minister or an ordinary citizen. Everybody has a role to play.

I shall start with the people who have dementia, along with their families and their carers. When we promote policy, do collaboration or talk about international research, we must constantly remind ourselves that the people with the disease and their carers and families are usually the most expert people in the system. Therefore, the services that we provide, the quality of care and the innovations we develop have to be shaped and guided by those people. We must empower them to make their voices heard in this debate. When we bring together our creativity, our imagination and the huge brain power in the research community, we must always bring to this issue, too, our own humanity. We must remember that people with dementia are valuable and loved human beings. If we can keep that at the forefront of our minds, we will make progress and be doing absolutely the right thing.

During Question Time yesterday I mentioned a lady called Joy Watson. I met her a little while ago. She is only 55, but she has early-onset dementia. Her family was devastated. When she went into shops, she might be a little confused over her change or what she needed to order, and the shops—and sometimes the customers—would be irritated with her, tutting and asking her to hurry up. She took to wearing a badge, which she designed herself, saying “I have got Alzheimer’s; please be patient with me”. She should not need to do that. Nowadays there is a scheme—I think it is called the purple angel scheme, and Joy is promoting it—so that people can wear a purple angel on their T-shirts as a means of raising awareness in every single part of our community.

In Salford, we have worked on this agenda for a number of years. We have just formed our dementia action alliance, with 30 organisations now committed to action plans to make us, I hope, the first dementia-friendly community in Greater Manchester. As well as health, education and housing bodies, we have the Lowry arts centre and our shopping centres included in the scheme. I think we have the first private-hire taxi firm in the country to be involved in this, Mainline Sevens taxis. It has trained 400 drivers and has an account system so that people with dementia do not have to fiddle with their money when they get in a taxi. All those groups are now dementia aware. That shows the really practical things that can be done.

On the research side, I am delighted to say that tomorrow, Salford university will launch the Salford Institute for Dementia, bringing together the faculty of health and social care with departments dealing with the built environment, computers, IT, arts and media—showing the multidisciplinary approach that will apply. That group will draw together and disseminate research on living well with dementia. I think this is a fabulous academic development.

[Mrs Moon]

I cannot say how much I admire my right hon. Friend’s championing of this cause. When it comes to universities, there are examples of research that have focused on ideas for prevention. We heard yesterday from Professor A. David Smith from Oxford about the vitamin B6 and B12 levels as a means of achieving this. Currently, it is not possible within the health service to have a test of homocysteine levels that would help to identify the problem. Could we not put that prevention in place; should we not be doing that now?

[Hazel Blears]

My hon. Friend is absolutely right. I was horrified to learn yesterday that only 0.1% of research on dementia is spent on prevention. In every other area of public policy, such as education and social mobility, we are aware of the importance of investing in prevention, but in this area there is virtually no grant support, and that must change. I understand that in Norway and Sweden, tests for dementia are the norm. They are cheap once the investment has been made in the equipment, and the vitamin B12 research looks extremely promising. I hope that when the Minister responds he will say that that is something that our own national health service should take up.

Tobacco Packaging

Madeleine Moon Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

I know my hon. Friend feels strongly about this issue, but nobody is banning anything. Were the Government to proceed following receipt of the review, the proposal would be about packaging, not the ability to purchase tobacco. All the sorts of points that my hon. Friend has often articulated were well made during the consultation, which, as he knows, received an enormous response, and all the responses will be made available to Sir Cyril.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Some 190 health organisations recognise that plain packaging will cut smoking, particularly among the young, and have urged action. Is this not just a further delay while the Government get their house in order so that they know how and when to introduce the legislation that is so urgently needed?

[Jane Ellison]

The hon. Lady is right to say that many charities feel strongly about this issue and I was pleased that the chief executive for Action on Smoking and Health said this morning:

“This decision is a victory for public health, for common sense and for future generations”.

Tobacco Packaging

Madeleine Moon Excerpts

Thursday 7th November 2013 Commons Chamber

[Bob Blackman]

The fact is that smoking is a lethal addiction. We know that. It is the one product in service in the world where, if used in the way it is intended, will lead directly to poor health and possibly death. Across England, 80,000 people a year die from smoking-related diseases. There are more premature deaths from smoking than from obesity, alcohol, illegal drug use and AIDS put together. It is the biggest single killer. In the long run, if we can get a fall of just one percentage point in smoking prevalence rates, we could save 1,800 lives per year. Who would not wish to save 1,800 lives per year? There cannot be an effective public health policy unless tobacco control is at its heart.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Every one of us in the House will remember how, in our youth, cigarettes were marketed as fashionable, trendy and stylish. With 200,000 children starting smoking every year in Britain, and 11,000 in Wales, is it not right that we send a very clear message that smoking is not trendy or stylish; it is a killer?

[Bob Blackman]

The hon. Lady comes on to a particular issue. The vast majority of smokers begin smoking in childhood. Two thirds of current smokers began under the age of 18 and we know that 200,000 young people under the age of 15 begin to smoke every year. When you add in the people that begin to smoke between 15 and 18, it becomes 300,000 smokers per year. Once someone is hooked, it is very difficult to give up. Most people say that after the direct sale of cigarettes to minors was made unlawful, many young people still continued to start smoking. Cancer Research stated in 2011 that more than 200,000 young people under the age of 16 had started to smoke. We must make sure that we reduce that number quite drastically.

Mental Health

Madeleine Moon Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a privilege to follow the right hon. Member for Sutton and Cheam (Paul Burstow). The House will recognise the work that he has done in bringing this issue not just to our attention, but to that of the wider public. I also pay tribute to the hon. Member for Broxbourne (Mr Walker), who has done fantastic work in this area, and to my hon. Friend the Member for North Durham (Mr Jones). [Interruption.] My hon. Friend moves away from me just as I am commending him.

I want to consider mental health issues in the armed forces, because there is an urgent need to address some myths and problems. The armed forces also have wonderful examples of best practice that are not generally appreciated and have not been dispersed throughout wider mental health services.

Looking back in time, there were 80,000 cases of shell shock or battle fatigue during the first world war. The British Government, realising that they had to do something because of problems in getting troops to the front line, started looking at mental health. Changes in mental health treatment started because the military needed to deal with mental health problems.

[Jeremy Corbyn]

My hon. Friend is making an important point about the experience of the first world war. Does she recognise that there was a great deal of discrimination against and abuse of ordinary soldiers who suffered mental health trauma as a result of the first world war, whereas some of the officers who suffered it got therapeutic treatment in special homes around the country? There was an enormous difference between the approach taken to soldiers and to officers.

[Mrs Moon]

My hon. Friend is correct. Craiglockhart hospital and the work of Dr Rivers are a prime example of the excellent treatment that was given to some officers. Many people continued to cope with post-traumatic stress disorder, which we now recognise. It was not identified as a condition at the time, although it is detailed in some post-war journals. We have, however, moved forward.

To return to my original point, the military is often at the cutting edge—it needs to be—of looking at mental health problems. Post-traumatic stress disorder has risen up the mental health agenda in the armed forces, mainly because of statistics from the United States. The US Department of Veterans Affairs estimates that post-traumatic stress disorder affects 11% of veterans of the war in Afghanistan and 20% of Iraq war veterans. By contrast, the figure for the UK—these statistics are taken from a 2010 edition of The Lancet—is 4%, while 19.7% reported more common mental health disorders and 13% reported alcohol abuse.

I want to consider the issue of alcohol abuse in the armed forces and its impact on mental health problems. The Ministry of Defence has spent a lot of time providing services, raising awareness and developing programmes such as TRiM—trauma risk management—which I will look at later, and there is far greater understanding of mental health problems among the military. Much of that is thanks to the excellent work of and collaboration between the MOD and King’s college London. I draw Members’ attention to “King’s Centre for Military Health Research: A fifteen year report”, which was published in 2010 and sets out the stunning work that has been carried out. It talks about the roll-out of TRiM. The unit has helped to raise the awareness of most common mental health problems among military personnel, including depression, alcohol misuse and post-traumatic stress disorder, although that is not the most prevalent. The unit found that pre-deployment screening was not effective in picking up problems and that mental health problems did not necessarily apply only to those whose problems had been indentified before they were deployed. Who will be affected by deployment cannot be predicted.

[John Glen (Salisbury) (Con)]

In the hon. Lady’s investigations into this critical area, has she discerned any difference between the ways in which reservists and regulars are treated with respect to screening and treatment? If she has, does she think that that needs to be addressed?

[Mrs Moon]

I thank the hon. Gentleman for his intervention. When he was on the Defence Committee, he took a particular interest in this area. As I will explain later, reservists are particularly vulnerable. That is more of a problem in the US because they are deployed for longer and have less support once they are home. However, it is a major issue that we must address in the UK as we increase the percentage of reservists in our armed forces.

The work at King’s college London highlights the importance of adhering to the Harmony guidelines and the negative impact of changing tour lengths during tours. The Secretary of State for Defence announced in a statement yesterday that we are extending the tour length for two brigades that will be deployed over the next two years. That has implications and we must ensure that King’s college London is involved in tracking the changes that it brings.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the hon. Lady give way?

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[Mrs Moon]

I will, but this is the last intervention that I will take.

[Rehman Chishti]

The hon. Lady is talking about the research undertaken by King’s college London. Experts at Imperial college London have said to me:

“Mental Health Services and research are a UK success story. We have produced world leading research in many areas which has led to new treatment approaches which have improved patients’ lives”.

Will she join me in paying tribute to all the researchers and academics in our country who have done so much to improve the quality of care for patients?

[Mrs Moon]

The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.

The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.

Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.

I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.

I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.

US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.

Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.

There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.

Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.

Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.

Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.

[Norman Lamb]

The hon. Lady makes important points on people in the armed forces and veterans. Is she aware of Lord Adebowale’s valuable work and report on the link between police and mental health, which was published last week? It was commissioned by the police and dealt with how to improve the way in which they operate. It is good news that the police were prepared to commission Lord Adebowale’s report and are prepared to listen to his advice.

[Mrs Moon]

I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.

Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.

[Mr Kevan Jones (North Durham) (Lab)]

I agree totally with my hon. Friend that each of those 95 people taking their own lives is an individual and family tragedy. My problem is that, in opposition, the Conservatives, including the Prime Minister, took the figure used prior to the research and quoted it freely, like confetti, to try to discredit what the Labour Government were doing for veterans’ mental health.

[Mrs Moon]

I tracked that figure back and found that it initially came from a story in the Daily Mail. That is how currency becomes fact.

[Mr Jones]

It was repeated by the Conservatives.

[Mrs Moon]

The repeating of such figures is the dangerous part as it places the perception in people’s minds. More dangerously, it goes into the minds of veterans, who then think, “I have served. I will have a mental health problem and post-traumatic stress disorder,” when the opposite is true. It is incumbent on all hon. Members to ensure that our work and the facts we share come from academically proven research. A study by Lord Ashcroft suggested that 92% of the public believe that all veterans will have a mental health problem, but research suggests that the opposite is true—that 90% do well.

We have had a 15-year report from the King’s Centre for Military Health Research, but we need a 20-year report showing the impact of the draw-down from Afghanistan and the increased numbers of veterans in the community.

In this debate on mental health, words can be dangerous—they can harm and create impressions in vulnerable minds. They can make people believe they have a problem they do not have, or that they have a problem that they can survive and grow from. Military mental health is robust. The transition to civilian life, alcohol misuse and reservists are risks that we must take seriously and tackle. The MOD will need to work more closely with the Department of Health. As people leave the armed forces and become civilians, civilian society organisations need to be equipped and ready to help. As civilians, we face the same problems together.

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[Mr Walker]

The hon. Gentleman makes an excellent point. Patients need a voice and an advocate, and often—not always, but often—a family member is best placed to do that. The patient’s wishes should be respected.

[Mrs Moon]

I wanted to follow up on the same issue as the Minister. In preparing for this debate, I received many e-mails from people who had to become experts in the condition in the hope of protecting a family member from exactly the sort of abuse that the hon. Gentleman is talking about. The fear that carers feel when a loved-one comes into contact with the health services, which should be there to protect them and aid them in their passage through their illness, should not exist. That fear should not add to the trauma of their treatment. That is something we have to address.

[Mr Walker]

It is not a crime to be ill. It is not a crime to have cancer, it is not a crime to have heart disease and it should not be a crime to have a mental health illness. What we need is compassion.

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[Mr Jones]

We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.

[Mrs Moon]

There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.

[Madam Deputy Speaker (Dawn Primarolo)]

Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.

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[Jane Ellison]

I could not agree more.

My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.

In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.

The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.

There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.

[Mrs Moon]

The hon. Lady is making some very interesting points, but the focus of this debate is mental health. Perhaps she could conclude by pointing out the mental health messages—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is for the Chair to decide what is in order and what the debate is about. I need no help from the Back Benches, although it was very kind of the hon. Lady to intervene.

Health and Social Care

Madeleine Moon Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Burstow]

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

[Paul Burstow]

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

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[Barbara Keeley]

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

[Mrs Moon]

Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

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[Mrs Anne McGuire (Stirling) (Lab)]

It is a pleasure to speak in this debate and to follow the hon. Member for Aldershot (Sir Gerald Howarth), although obviously I would not necessarily agree with all his comments.

I was not going to say anything about immigration, but sometimes we need to look to ourselves when we talk about that subject. I suspect that there is not one individual here who has not had at one point in their background an immigrant who came to the United Kingdom. Those who talk about the “native British” need to reflect on the fact that Britain has always had immigrants—from the Vikings to the Huguenots and from the Dutch to the Irish. My father told me that our family were descended from members of the Spanish armada who were shipwrecked off the north coast of Ireland when they were trying to avoid the English fleet. We need to reflect and have a rational debate about immigration, not the hysteria that there sometimes is in this House.

[Mrs Moon]

Will my right hon. Friend give way?

[Mrs McGuire]

Very quickly, because I want to get on to the main substance of my speech.

[Mrs Moon]

Should we not get some of the figures clear in our heads? According to the Department of Health website, the actual cost to the NHS budget of the amount spent on foreign nationals is a mere 0.06%. This is not something that we cannot afford.

[Mrs McGuire]

As I have said, I do not want to go down that track but, having been nursed in a UK hospital by non-indigenous British staff, I think we ought to be more balanced in our comments on immigration.

The main focus of this debate—health and social care—is a vital issue for many people; even if they do not think so at present, it certainly will be in the future. As we are all aware, the changing demography and advances in modern medicine and technology have thrown up challenges to our society in how to develop the capacity for social care and, indeed, how to pay for it. The issue is not unique to the United Kingdom; it is a challenge in many countries across the world. As has already been said, the Administrations in Wales and Scotland are developing their own policies in the realm of social care.

Although the legislation under discussion relates to England specifically, I want to discuss some general issues that cut across the debate in the whole of the UK. Like my colleagues on the Opposition Front Bench, I welcome some aspects of the Care Bill, which builds on the work undertaken by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, when he was in government. I hope that the Bill will simplify the existing regulations, provide some confidence that lifetime assets will not be swept away by care costs, and—I stress that I hope that this will happen—eradicate the postcode lottery of care, introducing an element of consistency to the system. The Bill should also give stronger legal rights to carers—I echo the words of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—who are often the forgotten players when we debate social care.

Having said that, there are still some major areas of concern and I want to concentrate on them. Frankly, they throw up challenges for everyone in this House, regardless of which political party we belong to. I am not convinced that the Government have thought through where young carers fit into the big picture painted by the new Bill. It is, of course, a welcome development that, for the first time, councils will have to meet the eligible needs of carers for support. I also welcome the aim for a family assessment, which in some areas should pick up the pressures on young carers.

Many organisations representing young carers, however, feel that many concerns have not been covered adequately. The well-being of young carers very much depends on the level of support that the person they care for—more often than not their parent—receives. If that support is not adequate, an unacceptable pressure remains on young people who should, to be frank, be doing other things. Council budgets are being stretched and care and support is being restricted in many instances to those who have critical or severe needs, so an unacceptable burden is still being placed on young carers who support family needs but who will not meet the new exacting standards.

I do not want to reiterate some of the points that other hon. Members have made about the need to move from the current random method of identifying young carers to a more systematic approach. I want to spend a few moments on the issue of working-age people who need support from our social services. Too often the debate on social care concentrates on older people, but it should not focus on them alone, because the reality is that about a third of people who rely on support are of working age and they are often forgotten. I am sure we will all agree that a younger person’s need for support from the care system is not necessarily the same as that of an older person. To that end, the all-party parliamentary groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler), as chair of the local government all-party parliamentary group, and Baroness Campbell of Surbiton and myself, as joint chairs of the disability all-pary paliamentary group, were delighted that 10 parliamentarians of all parties and from the Cross Benches in the Lords agreed to undertake an independent inquiry.

The report will be launched officially on Wednesday, so I will not pre-empt its findings. I hope that colleagues will take time out of their schedules to come along and hear what the disabled people, organisations and experts that appeared before the inquiry committee said. The evidence is powerful and I hope that people will read it. When we debate health and social care over the next few weeks, I hope that we will listen to the voices of the people who matter: the people on the receiving end of the system. What they say gives us food for thought and food for action.

It is well documented that more than a third of the people who receive social care are of working age. We must also recognise that most of the pressure and innovation will be at a local level. It is important that we encourage local organisations and local government to ensure that there is innovation in the system. As my right hon. Friend the Member for Leigh said in his opening remarks, there is a funding crisis in local government that no amount of innovation can mitigate. There is only so much innovation that any system can support without the recognition of financial instability. It is not just Labour councils that are saying that to the Government; councils of all political persuasions are trying to persuade the Government that they cannot continue to support the pressure that is being placed on their social services.

Finally, we have spoken a lot about the cap and the protection of assets. The Government have not been clear about what will happen to people who do not have the capacity to build up assets, and I am talking about working-age adults who are disabled who have not had that opportunity. The overwhelming majority of people with learning disabilities will not be affected by a cap because they do not have an asset base to protect.

I hope that there will be a robust, challenging and honest debate about the future of social care.

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[Chris Ruane (Vale of Clwyd) (Lab)]

I wish to speak on four matters in today’s debate on the Queen’s Speech. The first—heart-related issues—has already been mentioned by my right hon. Friend the Member for Rother Valley (Mr Barron) and by the hon. Member for Mid Derbyshire (Pauline Latham), who is no longer in her place. I am the chairman of the all-party parliamentary group on heart disease, which was set up 12 years ago. I give credit to the Government for consulting on minimum pricing of alcohol and on plain packaging for cigarettes and tobacco. Both those consultations have been good, engaging MPs from all parties and, indeed, the wider community, but the Government have lost a golden opportunity to put these measures in this year’s Queen’s Speech.

Over the past 10 or 12 years, we have had a fantastic record on heart disease, with deaths going down by 46%. We have taken some big and bold decisions: for example, the Labour Government passed a measure to ban smoking in public places; we also introduced statins, which are largely responsible for the 46% drop in heart-related deaths. We must keep up the momentum, however, and minimum pricing of alcohol and plain packaging of cigarettes could have helped us to do so.

Each year, about 11,000 10 to 15-year-old children in Wales take up smoking. The industry wants to catch those smokers young and keep them smoking until they are 55, 65 or until they die, in order to keep up profits. Those young people have been deliberately targeted. The hon. Member for Mid Derbyshire mentioned the use of defibrillators and the teaching of resuscitation skills in schools. If the Government made progress on those, it would help to keep up our excellent momentum on tackling heart disease in the UK.

Many Members have touched on immigration and some have connected it with the health service. There will not be one of us in this Chamber whose life has not been touched by an immigrant worker in the NHS. My doctor for 25 years, Dr Rao—sadly, now passed away—came from the Indian subcontinent, while the man who delivered my first-born child was an Egyptian consultant, and I am really grateful to both of them. If all the immigrants working in the national health service left tomorrow, our national health service would collapse. I pay tribute, too, to the Filipino workers in the care sector—lovely, family-orientated people, who have great respect and great compassion for the elderly. Immigration is an issue throughout the country and we need to reflect concern about it in Parliament. What we do not need to do is add to it. We certainly do not need to whip it up, as I feel some Members have done today.

I praise the hon. Member for Mid Derbyshire for what she said about cancer treatments. I pay tribute to the work of my constituent Mike Peters, a friend of mine, who has had cancer twice in his life and currently has a chronic leukaemia condition. Mike is spearheading an international campaign to increase the number of donors of matching blood cells for leukaemia treatment. He has set up two organisations, the Love Hope Strength Foundation and Delete Blood Cancer UK. He is a rock star who is a lead singer in The Alarm and Big Country, and he tries to recruit people when he sings in countries around the world. He has personally recruited 35,000 donors, mainly in America, through his concerts, and 500 people’s lives have been saved as a result.

Mike is holding an event in Room R in Portcullis House on Tuesday 4 June. Anyone—any Member of Parliament!—aged between 17 and 55 will be welcome to become a donor. All it takes is a mouth swab. The DNA is then kept on file, so that anyone in this or any other country who needs stem cells will be able to gain access to them. Let me again pay tribute to the work that Mike Peters has done.

I now want to say something about how mindfulness can help with problems related to health and social care. Members may ask “What is mindfulness?” Mindfulness is an integrative mind-body-based approach which helps people to change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so that we become more aware of them, less enmeshed in them, and better able to manage them. It uses breath as an anchor to slow down the mind and body and to help us to live in the present moment, rather than being chased by our past or worried by our future. It is the perfect way to combat stress—and the impact of stress on heart problems, cancer and mental health conditions is massive.

Members may think that that sounds a bit airy-fairy, but the National Institute for Health and Clinical Excellence has backed mindfulness as a better way of treating repeat-episode depression than drug therapy. It puts the individual in control. It is as cheap as drug therapy in the short term, and cheaper in the long term. It has no known side-effects, and, if taught early enough, it is preventive. Let me give the House some statistics. A total of 32.3% of people aged between 15 and 25 suffer from one or more psychological conditions. Every Member in the Chamber will know someone with such a condition, perhaps even a family member. In 1991, 9 million prescriptions for anti-depressants were issued; in 2011, 46 million were issued. That is a 500% increase in 20 years.

[Mrs Moon]

As my hon. Friend says, one of the problems on which we need to focus is depression among young people. Young people oppose the idea of taking anti-depressants. Will my hon. Friend say something about the importance of mindfulness in enabling them to build up their self-awareness, their self-confidence and their ability throughout their lives to handle possible recurring depression?

[Chris Ruane]

I know that the incidence of suicides among young people is a particular issue in my hon. Friend’s constituency, and mindfulness has a role to play in that context.

Many Members have mentioned compassion today. Mindfulness can help to give compassion to the individual and also to the health care worker. If compassion is lacking, mindfulness can enhance it. It can be used within the health care system, and has been taken up by doctors who are then in a better position to relate to their patients. Earlier this year there was a mindfulness session in the House of Commons for Members of this House and the House of Lords, and another will begin on 4 June.

Mindfulness can help in a personal capacity, but it can also assist the development of policy in prisons—85% of prisoners have mental health conditions—in education, in the armed forces, in the police and fire services, and in any area where there is trauma. It can play a big role throughout society and in all departments. I urge the Department of Health to recognise that, to act on NICE’s 2004 recommendations, and to ensure that the use of mindfulness for the treatment of repeat-episode depression is fully implemented. I also urge the Department to consider carefully its possible use in other parts of the national health service.

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[Dan Jarvis (Barnsley Central) (Lab)]

I am grateful for the opportunity to contribute to the Queen’s Speech debate on health and social care. Protecting the health of young people, reducing preventable deaths and safeguarding the health of Britain’s population are three important goals, but the absence of a Bill to introduce plain packaging for cigarettes undermines the Government’s commitment to those goals.

Cancer is an illness that touches many people’s lives. Although research is key to finding new ways to treat cancer, the Government can take simple and practical measures to avoid preventable deaths. Last week, the Government failed to introduce one such measure that could help to reduce cancer and other forms of smoking-related disease.

The introduction of standardised, plain packaging had been heralded as a good idea by a number of members of the Government. The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), a member of the medical profession, had previously shown his support for plain packaging. He said that plain packaging

“could certainly help to reduce the brand marketing appeal of cigarettes to teenagers, and most importantly, help to stop young people from developing a smoking habit that can only shorten their lives.”

I agree with him. The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), has stated that the evidence she has

“seen suggests that it is the attractiveness of the packets that leads young people to decide to take up smoking.”—[Official Report, 16 April 2013; Vol. 156, c. 561.]

I agree with her, too, and yet, three years into this Parliament, no action has been taken by the Government.

According to Cancer Research UK, more than 100,000 deaths are caused by tobacco each year in the UK. That could be much reduced if the Government took meaningful action. Between 2006 and 2007, the Labour Government took action to curb the harmful effects of smoking by banning smoking in public places. As the shadow Secretary of State for Health has said, the introduction of plain packaging for cigarettes is a natural progression, and as the Leader of the Opposition said in his response to the Queen’s Speech, plain packaging is the right thing for public health and the right thing for the country. I agree with him.

Since the Government consultation on plain packaging closed some nine months ago in August 2012, more than 150,000 children will have started an addiction to a substance that results in the death of half its long-term users. I accept that the introduction of plain packaging is not a silver bullet, but neither is it the nanny state, as some have described it. Plain packaging is a means of preventing young people from taking up a habit that, in the long run, could cost them their lives. Some 257,000 11 to 15-year-olds become smokers each year, and that number is unacceptable. We already have legislation to prevent children below the age of 18 from buying cigarettes. We banned smoking in public places, but more needs to be done.

[Mrs Moon]

The allegation is that it would be a nanny state if we introduced plain packaging. Is that not a contradiction, given that we know that state intervention often saves lives? If we had been worried about the nanny state, we would never have introduced seat belts or drink-driving laws, yet we would never move back from those. Is it not time we moved forward on plain packaging as well?

[Dan Jarvis]

I completely agree. The term “nanny state” has been used, but we want to prevent young people from taking up a habit that in the long term could cost them their lives. In 2013, Labour Members are on the correct side of the debate, which is also where the public are.

We should pause to consider the financial costs of smoking, which can be seen in its impact in towns such as the one I am proud to represent. The financial costs encompass much more than heightened NHS expenses; lost output and lost productivity both increase the price associated with smoking. For Barnsley alone, smoking creates a bill amounting to £75.3 million each year.

Yet the financial cost is small compared with the human cost. In Barnsley, there are 485 adult deaths from smoking each year. Despite that, nearly 1,000 children in Barnsley aged between 11 and 15 take up smoking each year and approximately 1,100 10 to 14-year-olds there are regular smokers. Like the rest of the UK, Barnsley has paid too high a price. It is time that action was taken to prevent the costs of smoking from stretching further and further into the future.

Let us be clear: advertising works. If it did not, the tobacco industry would not spend such vast amounts of time, money and effort on packaging presentation and it would not be opposing plain packaging with such vigour. For the tobacco industry, packaging is a form of advertising that helps to keep existing customers loyal and attracts new ones. On that point, the World Health Organisation is clear:

“Marketing of tobacco products encourages current smokers to smoke more, decreases their motivation to quit, and urges”

young people to start.

Of course children will be attracted to sophisticated and glamorous packaging. When he was Health Secretary, the Leader of the House echoed that view, stating:

“It’s wrong that children are being attracted to smoke by glitzy designs on packets…children should be protected from the start.”

Unusually, I agree with him.

A lack of evidence cannot be used as an excuse for delaying the essential legislation. Advertising does impact on young people’s decisions, and in the context of smoking that means that children’s health is put at risk. The trade-off between the tobacco industry and children’s health has been in favour of the industry for too long. It is time that something was done to redress the balance.

There is also clear support for plain packaging from the public. Last year, 63% of the UK public supported standardised, plain packaging and only 16% of people opposed it. A lack of public support is not holding the Government back from introducing the legislation; in fact, 85% of people back Government action to reduce the number of young people who start smoking.

By delaying the next step in smoking prevention, the Government are not only putting a future generation’s health at risk, but ignoring a key issue that British people want and need Parliament to address. There is the evidence, the public support and the moral imperative to act, yet the Government have so far failed to take the definitive action needed to save lives, reduce health care costs and prevent children’s health from being put at risk.

Madam Deputy Speaker, please accept my apologies for not being able to attend the winding-up speeches. Let me conclude by saying that I am in no doubt that plain packaging is the right thing for public health and the right thing for the country. I am in no doubt we will have plain packaging. When we get there, we will wonder why it took so long to protect children against the harmful impacts of smoking and about the lives that could have been saved if we had acted sooner. We can stop that wondering if we act sooner rather than later. We know that advertising works and that smoking kills. It is time to do something about it.

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

There are approximately 6 million carers in the UK, 2.2 million of whom provide more than 20 hours of care a week. Between them, they provide more than £119 billion- worth of care each year. They are listening to this evening’s debate. They want to know whether what is in the Queen’s Speech are empty words and further promises, or whether their lives will improve and changes will be made.

A lot of people have spoken of the work undertaken by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in the complaints review. I have sent copies of the letters I wrote when I made a complaint about the absolutely appalling treatment of my mother in an English hospital over a number of visits. I worked hard to make the complaint stick and ensure that my voice as her carer was heard, but even I, as a Member of Parliament, was worn down in the end.

I have sat in this debate and listened to Government Members criticise the Welsh health service. I have a very sick husband. He uses the Welsh health service, and I am grateful for the quality of care that he receives from it every day of the week. I know that my GP service is excellent and I know that if I need care from my local hospital for him, it is there, so I want to hear no more nonsense about the Welsh health service.

[John Glen]

Will the hon. Lady give way?

[Mrs Moon]

No, I will not; I am in the midst of my speech.

In Bridgend, there are 18,000 people providing care for relatives or friends. Some 5,500 of them provide unpaid care for more than 50 hours a week—care that is compassionate and dedicated; care of a quality that we would love to hear is being provided in our hospitals. I asked a group of carers recently what it meant to be a carer. One of them said, “It’s like trying to live two people’s lives and cramming them into one person’s life.” The other said, “You’re an expert in bodily fluids. Urine, faeces, blood and vomit are the daily recipe.” Is it any wonder that the Royal College of General Practitioners recommended last week that all carers should be screened for depression? It recognises that carers are particularly susceptible to depression and that there is a need for greater support.

Carers UK has reported that almost a third of those caring for 35 hours a week or more receive no practical support, while 84% of carers surveyed said that caring had a negative impact on health. That is up from 74% in 2011-12, so the problem is getting worse. Four in 10 —42%—of those caring for someone discharged from hospital in the last year felt that the person they were caring for was not ready to come out of hospital and that they did not have the right support at home. I worked in discharge care in a number of hospitals in Wales. Safe discharge was a major platform on which we worked. The things that are a problem remain the same. There is a lack of specialist equipment readily available for carers to assist with discharge—I am talking about beds that prevent bed sores, hoists, commodes, adapted bathrooms, swallowing assessments, speech and language therapy, occupational therapists and physios. It is not just nursing we need to focus on; it is all those important services.

We also need to look at the availability of treatment and medication that make a difference to people’s lives. I want to talk briefly about a condition that really shocks me and the carers of those who have it: aHUS, or atypical hemolytic uremic syndrome. I am the co-chair of the all-party kidney group. A few weeks ago I chaired a meeting of people with aHUS. There is a drug available for the condition that is called—excuse me, Madam Deputy Speaker, but it is a dreadful drug to pronounce—eculizumab. It sounds like some sort of African tribe, but that is what it is called. Taking eculizumab can virtually cure someone with aHUS. They get their life back. We are talking about a very small number of people who have the condition—less than 170. The typical form is triggered by a bacterial infection such as E. coli; the atypical form is genetic. We heard tragic evidence from families in which perhaps three or four generations of children and adults carried the genetic trigger. More importantly, the only treatment other than taking eculizumab is to have dialysis on a virtually daily basis. We heard from carers who have to place the extremely painful and long needles needed for dialysis into their children’s arms. Those children cannot have a kidney transplant because the transplant would almost certainly have the same condition. Even if they had a transplant, they would continue to need dialysis.

I am appalled to learn that the Government have agreed that those who are taking the drug on a trial basis may continue to take it, while those who have already been diagnosed but refused access to the drug on a trial basis will not be allowed access to it. Newly diagnosed patients will, however, have access to it. That is nonsense. We could save a large amount of money, and we could save those patients the trauma of daily dialysis. The drug was recommended for use by the Advisory Group for National Specialised Services and it has now been submitted to the National Institute for Health and Clinical Excellence for further appraisal. Sufferers of the condition might therefore have to wait until 2014 to get access to it, which is totally unacceptable.

Madam Deputy Speaker, I am sorry that I shall not be able to stay for the winding-up speeches, but I hope that the Minister will consider whether it might be possible for access to this drug to be extended to all sufferers of aHUS, so that they and their carers can once more have a decent quality of life, and so that the NHS can save money.

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

I thought that, rather than speaking about Europe or votes for prisoners, I might make a couple of points about health and social care.

There are many provisions that I should have liked the Government to include in their legislative programme. For instance, I should have liked to see a commitment to extending freedom of information requests to private health care companies. I should also have liked to see a commitment to excluding health care from the scope of trade agreements as part of a broader exclusion of public services. I understand that the Prime Minister is involved in negotiations at this moment, and I hope that the trade agreement issue is on his agenda, because there is an increasing fear among Opposition Members that—in that context, and also as a result of the Health and Social Care Act 2012—our health care system is being prepared for privatisation, and the way is being cleared for the mass entry of United States health care multinationals to the UK market.

I am pleased that the Care Bill is to be introduced in the current Session. It will go some way towards helping those who are most in need of social care, as well as their carers, providing as it does the first ever legislative framework for social care. It is a much-needed first step in the right direction, which has been a long time coming. However, it raises a great many issues. As usual with this Government, we need to look beneath the veneer and establish whether an opportunity is being taken or missed, and whether we are taking one step forward and several steps back. It would certainly be a retrograde step to raise expectations only for them to be dashed as people discover that the proposals are really quite limited. We need to be honest about what is on offer.

Members often receive some shocking and surprising statistics in their mailbags, but some of the most surprising pieces of information that I have seen relate to social care. I must thank a range of organisations—including Scope, Age UK, the Alzheimer’s Society, the TUC, the British Medical Association, Barnardo’s and the European Federation of Public Service Unions—for supplying briefings to me and to other Members. It shames me, and I am sure it shames Members in all parts of the House, that in Britain in the 21st century four out of 10 disabled people who receive social care support say that it does not meet their needs. That was established recently by research on social care conducted by the disability charity Scope following the publication of a report by the Joint Committee on the draft Care and Support Bill, on which I served. It is feared that the current provisions, and some of those that are proposed, will not be sufficient.

Other Members have welcomed the Bill. However, it is hugely worrying that local government finance has been hollowed out. That will have major consequences. It has been said that local government allocations for social care are protected, but they are certainly not protected when it comes to provision for transport and other supplementary services that are of value to members of the group involved. Many organisations have pointed out that setting eligibility criteria for care at “moderate” is essential if this framework is to be effective. As the hon. Member for Bradford East (Mr Ward) pointed out, according to the findings of a survey by Scope, by 2012 84% of councils had set their eligibility criteria at the “substantial” threshold. That represents an increase of nearly a third since 2005. As a result, only 14% of people with “moderate” needs are now receiving care, and the findings of recent surveys suggest that the position will only get worse.

According to Marc Bush, head of research and public policy at Scope,

“if we take moderate level needs, there are 36,000 people within the system of working age who, if the reforms go through as they are currently set, would fall out of the care system…if you do not meet need early, people's needs escalate and the costs escalate.”

Mr Bush’s evidence is in paragraph 186 of the Joint Committee’s report. Indeed, the Local Government Association has estimated that by 2019-20, 45% of council budgets will be spent on social care. Unless we increase substantially the amount of resources available—

[Mrs Moon]

There is pressure on people with illnesses and with disabilities if they do not get access to that social care, but should we not acknowledge the wider pressures on their families, who have to fill that gap all too often? That means taking time off from work and reducing the time spent on their leisure pursuits, thereby adding to family tensions.

[Grahame M. Morris]

That is an excellent point. The role of carers and families is absolutely critical; they are an army of unsung heroes.

We cannot build a quality care service based on driving down the terms and conditions of the people who deliver it. I am very concerned about the increase in the number of zero-hour contracts, through which staff are paid the bare minimum. Such contracts are increasingly being used by private care companies seeking flexibility when meeting short-term staffing needs, and they often lead to job insecurity and a lack of appreciation of workers. We are seeing the fragmentation of social care, driven by the pressure to cut costs, which only places obstacles in the way of quality and of integrating services. Contracting out and privatisation also make it more difficult to have joined-up services, and there is a real risk that local authorities will find it impossible to comply with their new duties.

We should be honest about what the Bill can achieve. It is a framework. It is paving legislation. It will not stop people having to sell their homes to pay for care. Under the existing deferred payment scheme, councils can loan money to people to cover their care costs, which has to be paid back by selling the family home after the elderly person has died. The Government propose something similar, but unlike the current system, interest is charged on the loan. The care Bill will not necessarily cap at £72,000 the costs elderly people actually pay for residential care. As has been said, hotel and other accommodation charges are not covered. Many elderly people in care homes will die long before they reach the cap that is being trumpeted as such a success. It certainly will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. Elderly people will get free care only if they have income or assets under the lower means-tested threshold, which is not being increased and will be £17,000 in 2016.

More widely, the care Bill does nothing to address the funding crisis in social care or to help those who face a daily struggle to get the support they need right now. Elderly and disabled people are facing huge increases in home care charges, which are a stealth tax on the most vulnerable people in society. Few older people are getting their care for free, and more older and disabled people are being forced to pay for more vital services that help them to get up in the morning and get washed, dressed and fed.

We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people to stay healthy and live independently in their own homes for as long as possible. That would truly reinstate the idea of people being looked after from cradle to grave—a worthy extension of Aneurin Bevan’s legacy. Labour’s alternative is integrated, whole-person care, incorporating health, mental health and social care in a truly national health and social care service.

Oral Answers to Questions

Madeleine Moon Excerpts

Tuesday 26th February 2013 Commons Chamber

[Anna Soubry]

That is a very good point. The overconsumption of alcohol, whether by a pregnant woman or not, greatly concerns the Government, and that is one reason we want to introduce a minimum unit price of 45p. It was a good point well made, and I am always happy to meet the hon. Gentleman to discuss the matter further.

[Mrs Madeleine Moon (Bridgend) (Lab)]

7. What funding his Department has allocated to research into pre-senile dementia.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.

[Mrs Moon]

I declare an interest.

Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?

[Mr Hunt]

I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.

Suicide Prevention

Madeleine Moon Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr McCrea]

I agree wholeheartedly with those remarks. The Bamford report highlighted the link with mental health. I agree that we must remove the stigma attached to mental health, as well as the stigma attached to suicide, because many families are deeply hurt by it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is the hon. Gentleman aware of research carried out by Louis Appleby, the suicide tsar, showing that 75% of those who commit suicide have had no connection with mental health services, and that it is dangerous to focus suicide help and support only on mental health teams? If we do that, we risk failing to protect many of those who need our help.

[Dr McCrea]

I thank the hon. Lady for her interest in this matter and for commendably seeking to highlight it in one of the Committee Rooms. There is no one reason for a person coming to that place where they feel that suicide is the only way out.

--- Later in debate ---

[Dr McCrea]

I thank my right hon. Friend for that intervention. In fact, the motion

“calls upon the Government to adequately resource and promote child and adolescent digital safety.”

The motion goes wider than that, but resources are certainly a problem that such organisations need help with.

The internet and new media are prominent features in youth culture nowadays. Young people see the use of technology as a vital part of their social lives, and the online environment has created unique opportunities for learning, connection and communication. Almost 99% of children aged between eight and 17 access the internet, and 90% of children aged five to 16 have a computer at home. Although the risks created by the internet and new media have yet to be properly assessed, there is growing concern over the use of the internet for cyber-bullying and for normalising and encouraging suicide and suicidal behaviour.

The Byron review, conducted in 2008, entitled “Safer Children in a Digital World”, found that

“there is a range of material on the Internet that may present particular issues for specific groups of children and young people. This includes content or sites that promote or give information about harmful behaviour such as suicide and self harm”.

The report found that, although some children might be deterred from harmful behaviours by witnessing such content, or might find emotional and social support from others experiencing the same feelings, it was clear that for some children there were major risks. Sites providing information about suicide techniques, for example, could increase the chance of a suicide attempt being successful and decrease the chances of a young person receiving help.

[Mrs Moon]

The hon. Gentleman will be aware that the hosting of such sites is illegal in the United Kingdom, thanks to the Coroners and Justice Act 2009. The problem is that many of those sites are hosted outside the UK, where they are not illegal. Internet providers need to block access to the sites. They move them down the access chain when people google them, but they do not block access to them altogether. How can we ensure that access to those sites is blocked?

[Dr McCrea]

I thank the hon. Lady for that intervention. I intend to touch on that point in a moment.

--- Later in debate ---

[Norman Lamb]

I thank my hon. Friend for that intervention. I would not want to indulge in cheap speculation about that. The statistics are clear on the prevalence of suicide among young men and clear that it is significantly higher than among young women. It is important that we carry out the research, which is why the Government have also committed to that as well; it is so that we gain a better understanding.

[Mrs Moon]

The Minister will be aware that research suggests that women and young girls are less vulnerable to suicide because they are help seekers, whereas young men are not and they will not articulate the problems they are facing. That is the major difference. Women and girls will go to their friends and talk about their problems, whereas men bottle things up so that they grow and grow and they can no longer manage them.

[Norman Lamb]

I thank the hon. Lady for that helpful intervention. What she says makes sense and I am most grateful to her for coming to my rescue on that—

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

I add my congratulations to those given to the hon. Member for South Antrim (Dr McCrea) on calling for this debate, along with his colleagues.

This is one of the few opportunities to address this important issue in the Chamber. There have been Adjournment debates and Westminster Hall debates, but a full Chamber debate is not a natural occurrence for this subject, so I very much welcome it. I begin with a quote from a recent inquiry undertaken by the all-party group on suicide and self-harm prevention. Someone working on suicide prevention in England said:

“So when you are having a discussion”—

as we are today—

“about what does suicide mean, and the numbers are very small compared to smoking or obesity, what is this about, well our deaths by suicide show…the ultimate loss of hope, the ultimate loss of meaning of purpose, yet they are an indicator. They may be small numbers, but they have a very big ripple impact and they are an indicator of what is happening further down that pyramid.”

This debate, as has been said, is timely, because of the publication of statistics by the Office for National Statistics which show that there has been an increase in suicides in the United Kingdom. In 2011, there were 6,045 suicides—an increase of 7.8% on the previous year. Across the United Kingdom, suicides have increased at different levels. In Wales last year, there was an 18.4% increase, and in Scotland, a 13.8% increase. However, Scotland has changed the data on which it bases its statistics, and it argues that if it had not changed statistical gathering information and the classification of deaths by alcohol, there would have been a small decrease.

In Northern Ireland, the figure is down slightly by 7.7%, from 313 to 289 deaths from suicide, but in 2009, it was as low as 260, so over that period there was an increase. In England, however, there is a 7.4% increase, but the figure varies across the country. In the south-east, it is 6%, but in the north-west, it is 9.3%, which will be of particular interest to you, Mr Deputy Speaker. The highest risk group—and there has been a lot of talk about young people, particularly young men—is men aged 30 to 44, with 23.5 deaths per 100,000. The 45 to 59 age group has the highest rate of suicides among women, and there is also an increase in deaths for men in that group.

When the ONS says there has been a significant increase, it means that we can be 95% confident that the increase has occurred because of an underlying reason, and not just by chance. Our job is to look at that underlying reason. What is driving these increases?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does the hon. Lady agree that when Members and others deal with families who are trying to come to terms with a suicide, very often there is a lack of help when those families try to identify within the family circle a behavioural change and problem that led up to the suicide? Sometimes they are racked with guilt because they cannot identify the problems that ultimately led to the suicide. Perhaps that is where attention and resource can be deployed.

[Mrs Moon]

I apologise to the House. I have lost a contact lens, and I have to wear spectacles. I cannot read my papers when I am wearing them, and I cannot see all hon. Members in the Chamber when I take them off. If I am not wearing them, hon. Members must alert me if they wish to intervene.

The hon. Gentleman is absolutely right. Families tear themselves apart over the question of why. They try to analyse behaviour, particularly in the weeks leading up to the death, to seek an understanding of it. Only if there is a suicide autopsy can one begin to look at the reasons behind a death. That is a complicated procedure that cannot be carried out for every death, but it can give some understanding of the wider reasons behind such deaths. I totally agree that the distress for families as to why the suicide has happened is horrific.

That is why the research to which we have access is important. Haw, Hawton, Gunnell and Platt found that the economic recession had a clear impact on suicide. However, the increase in the suicide rate may be offset by adequate welfare benefits; their finding was very clear on that. Other measures likely to reduce the impact of recession included targeted intervention for the unemployed and membership of social organisations. They found that responsible media reporting was also important. Research at the university of Liverpool found that more than 1,000 people took their own lives during the 2008-10 economic recession in the United Kingdom.

There are ways in which we can begin to look at some of the problems that are staring us in the face and that may be causing some of the increase that is becoming apparent. Suicides began to rise in the UK in 2008, following 20 years of decline. Figures rose almost 8% among men and 9% among women in 2008, compared with 2007. The figures reflect the increased effect of the recession. I want to reiterate that research has found that there are risks associated with failure to provide adequate welfare benefits. There are currently high levels of distress and hopelessness caused by the changes in benefit that are about to come into force.

[Jim Shannon]

I am sure the hon. Lady is aware that the Prince’s Trust recently released figures which show that one in four of those who are in work are almost always or very often depressed. Among those who are unemployed the rate rises as high as 50%. Does she feel there should be a focus on young people, who are suffering more than most? Her colleague—I cannot remember his constituency—had an Adjournment debate in the Chamber on that very topic and he highlighted the issue as well.

[Mrs Moon]

The figures show that the increased number of deaths are among an older group of men, largely those who have not experienced unemployment before, who find unemployment very difficult to deal with and who despair about being able to maintain their family lifestyle, pay their bills and see a future where they can again be economically successful. We must be careful that those who are unemployed and who need to survive on benefits for however short a period are not made to feel failures, a burden on the state or pariahs in our society.

I know that Ministers will probably argue that the Government are doing wonderful things in relation to benefits but the Office for National Statistic figures highlight a very worrying trend. I hope there will be discussions between the Department for Work and Pensions and the Department of Health to highlight the importance of Jobcentre Plus staff in particular being aware of claimants coming in who may well be suffering from depression and exhibiting signs of hopelessness and despair, and being able to take suitable preventive action.

Although the numbers are small compared with cancer, heart disease and dementia, suicide is a reflection of the overall health of a country and a community, and the ripple effects on the health of those impacted by it are very great. Other Members have spoken about the impact on families, but communities, schools and workplaces are also affected. There is an impact on people who have known the individual and people who identify themselves with that individual, which is where the risk is most dangerous.

[Geraint Davies (Swansea West) (Lab/Co-op)]

May I return to my hon. Friend’s point about the age profile of recent suicide victims? In going through the research, has she found that, in particular, men of a certain age, perhaps in their late 40s or early 50s, who have young children and who suddenly and unexpectedly lose their job, lose their self-esteem and cannot reposition themselves in what has traditionally been the caring-for-children role in the family setting? Does she think that there is a role for providing support to such people in regaining their self-esteem and repositioning themselves in order to get across to them that they have value in their new position, even if they do not get back their previous one, and to get them back on to a positive track rather than a downward spiral towards possible suicide?

[Mrs Moon]

My hon. Friend asks a complicated question. The research that I have looked at has considered the impact of suicide figures in recessions, not only in the UK but across the world, and it goes back in time to look at the great depression and recession that we had in the 1930s. As far as I am aware, no work has been done, certainly by that research group, on the impact on men’s self-esteem in assuming a caring role and responsibility within the family. Should I come across it, I will certainly pass it his way.

Last year, the all-party group on suicide and self-harm prevention, which I chair, considered a number of issues that we have to address in relation to suicide. Every meeting brings the best authorities that we can find into the corridors of Westminster to explain and talk about the work that they are doing.

[Michael Ellis (Northampton North) (Con)]

I congratulate the hon. Lady on the excellent work that she does in her all-party group. Has it looked into the specific issue of suicide in Her Majesty’s prisons and young offender institutions? Coming from a legal background, as I do, I am aware of that issue and wonder whether she has any observations to make about it.

[Mrs Moon]

I thank the hon. Gentleman for his intervention. We have not yet looked at that issue, but I pay close attention to it because I have Parc prison in my constituency. I hope at some point to secure an Adjournment debate on work that people are doing there on the Invisible Walls project, which builds and re-establishes links between prisoners and their families—their partners and children—because the best sense of rehabilitation that can be given to someone serving a sentence is the feeling that there is hope for a family life once they leave prison. That extremely important work is one of the ways we could focus on improving outcomes for people once they leave prison.

[Bob Stewart]

I suspect that the most vulnerable people are those who leave prison without a place to go to, in much the same way as, in my experience, soldiers who leave the armed forces go back to nothing if they have no family. Does the hon. Lady agree that we must take a great deal of interest in the people who have nothing, when they have a break from routine, such as leaving prison or the armed forces?

[Mrs Moon]

The Ministry of Defence commissioned a study by Dr Nav Kapur of Manchester university on suicide in the armed forces. He found that the largest number of suicides were by young people leaving the armed forces, usually without having completed their basic training or shortly after they had passed it. Further research is needed to confirm this, but the indications were that there was a feeling of hopelessness with regard to attempts to build a family in the armed forces, that a sense of success and of identity had been lost, and that that was perhaps one of the motivations towards suicide. Additional funding is needed for that research to be completed, but that was the outcome of the best study that I have seen so far of suicide in the armed forces.

The all-party group has discussed how coroners record suicide and the importance of accurate suicide reporting. I cannot stress that enough. One of the problems is narrative verdicts, which were introduced as an addition to a statutory verdict. If someone died in the custody of the Crown, for example, they allowed for a narrative of that death to teach lessons about how it had happened. Instead, however, they have replaced the verdict and become a verdict in their own right. Often, the death of someone who takes their own life by tying a ligature around their neck is not recorded as a suicide, because the appropriate word has not been used. The Ministry of Justice needs to work on this area. I know that it is doing so and I hope to meet the chief coroner soon to see how we can make progress.

[Mark Durkan (Foyle) (SDLP)]

Will my hon. Friend give way?

[Mrs Moon]

I will certainly give way to the hon. Gentleman, who regularly attends the all-party group, for which I thank him.

[Mark Durkan]

I thank my hon. Friend for giving way. The number of narrative verdicts in England is growing. One of the ways in which they are avoided in Northern Ireland is the decision taken five years ago by the coroners service not to hold inquests on suicides, but to just record them and not put the families through an inquest unless the public interest or another family requirement demands it. That means that there has been more sensitivity than the false sensitivity accorded to narrative verdicts, which then lead to flawed statistics.

[Mrs Moon]

I thank the hon. Gentleman for his intervention. I was not aware of that development in Northern Ireland, and I would like to spend some time examining it. The root trauma for many families who have experienced such a death is sometimes renewed, along with the publicity, up to a year later, which makes it very difficult for them to cope and which sets them back in the progress that they have made in grieving. Many have found it extremely difficult, so I will look at the information he provides, for which I thank him.

The all-party group has looked at the cross-Government strategy to prevent suicide in England. I will come back to that later, because it is a most important issue. We have also looked at suicide and bereavement. We talked to a number of families who have been bereaved by suicide and every one of them mentioned the importance of a Department of Health document called, “Help is at Hand”. Sadly, many Members do not know about this fantastic resource; it is not appropriately distributed and many families never get access to it. We have to find a way of getting that booklet out to people. The Welsh Assembly is looking to translate it and produce a Welsh language edition for Wales. We are also considering whether coroners and the police force would be appropriate groups to distribute that information.

We have also looked at the impact of police investigations. As Members will be aware, when a sudden death is reported, the police investigate initially under the murder manual. Families are therefore further traumatised by the feeling that they are under suspicion for the death. Once it is decided that it is a suicide, the police sometimes walk away and the family are left with no help or support and no sense of where they are supposed to go.

A suicide death is a lonely death because people stay away; they do not know what to say or how to approach the family. Often, the support that families desperately need is not there. That isolation and lack of information add to the risk of further suicides. It is important that people have ongoing support from within their community and from statutory services to see them through the grieving process.

We have also looked at the use of sport to reach out to young men. This point refers back to the question asked by the hon. Member for Beckenham (Bob Stewart) about the deaths of young men. It is important to give young men role models who have had difficulties in their life and who have contemplated suicide, despite success. Sports personalities have been particularly effective. We spoke with Ernie Benbow from State of Mind Rugby and Greg Burgess, the Choose Life co-ordinator for north Lancashire. They demonstrated how successful the use of sportsmen had been.

[Jim Shannon]

rose—

[Mrs Moon]

I am sure that I can see a hand gesturing at me. I will give way.

[Jim Shannon]

The hon. Lady’s eyesight is better than she thinks. Does she agree that TV soaps can play a key role in highlighting the issue of suicide and prevent viewers from committing suicide?

[Mrs Moon]

I thank the hon. Gentleman. There is a risk in how suicide scenes are written in soaps. There have been incidents in which a death by suicide in a soap opera has led to copycats and social contagion. The writing must be extremely careful. I know that many soap opera writers take their responsibility extremely seriously because they are aware of that risk.

There has been much talk about recipe websites. This week is internet safety week. It is extremely important that every Member of this House goes into schools in their area and talks to young people about staying safe on the internet. I went to Bryntirion junior school in my constituency last week and I asked a group of youngsters how many of them had ever received offensive material on the internet and how many of them had felt frightened, bullied or scared by what they saw. Every hand in the class went up. That is a world that we all escaped, but it is our duty to build awareness and protection in that world.

The work of the Samaritans is second to none. I want to highlight the work that it has done with British Transport police and Network Rail on the prevention of suicide on the railways. They have identified areas that have particular problems and trained their staff to be highly vigilant. They now provide support to people who enter their railway stations if they feel that there is a risk. That is a fantastic move forward.

I want to consider briefly the impact that the health and social care changes will have on the new suicide prevention plan for England. The all-party group carried out an inquiry into that. We issued a call for evidence that went out to all local authorities and directors of public health, via primary care trusts, local authorities and PCT clusters. That was followed by four evidence sessions in which we took evidence from representatives of the devolved nations, six areas of England and the voluntary sector.

The report concluded that the future of local suicide prevention plans in England depends on leadership and local champions, the identification of suicide prevention as a priority, availability of resources, and the long-term survival of suicide prevention groups already in place. The future of local suicide prevention plans in England is fragile and often relies on committed and dedicated individuals. That such plans are not a statutory requirement of the new national suicide prevention strategy is a major barrier to their survival, and that is particularly true when entering a time of restricted spending within local authorities. If something is not a statutory responsibility, often it will be bypassed or shelved.

There is no guarantee that health and wellbeing boards will address suicide prevention, or that existing plans will survive or be replaced. What will happen in areas where there is no suicide prevention plan and no history of taking an interest in the issue? In areas with no local champion, suicide prevention might be overlooked completely. We are talking about a suicide prevention postcode lottery, which is, in part, reflected in figures that show increases in suicide, differentiated across the United Kingdom.

There is no formal mechanism in the suicide prevention plan for England for suicide prevention groups to report directly to health and wellbeing boards. Without such a link, suicide prevention might not reach the agencies, and groups will be working in isolation, undermining their value and jeopardising their future. Engagement with the police, GPs and coroners is vital, yet in many areas such engagement is poor, patchy and inconsistent. Self-harm prevention and specialist bereavement services remain poor in many areas of the country.

Evidence from Northern Ireland demonstrates the importance of involving community organisations and the voluntary sector in suicide prevention. The existence of suicide prevention implementation groups in every locality was critical to Northern Ireland’s success and ensures that suicide prevention is not left to chance. The leadership at Government level highlighted by the hon. Member for South Antrim is also critical. Northern Ireland is making a difference.

In Wales, sadly, ministerial statements allocating responsibility for suicide planning were not published, and mandates were passed to local authorities but not implemented. That highlights the importance of national leadership, which comes up time and again in ensuring consistent implementation and showing what can result where no suicide prevention plan is in place. My local authority in Bridgend, however, is an exemplar of best practice and best planning. It learned a salutary lesson of the importance of such planning, which it now does excellently.

Evidence from Scotland highlighted the strength of a co-ordinated national approach to implementation—the Choose Life strategy—with the appointment of a co-ordinator in every local authority together with national funding and national leadership. The Minister of State, Department of Health, kindly gave an address at the launch of the report by the all-party group on suicide and self-harm prevention, and has agreed to respond to that on behalf of the Government.

Health and wellbeing boards need direction because otherwise we will end up with a hotchpotch of disorganised and unconnected policies, many of which have no evidence base. The National Institute for Health and Clinical Excellence is commissioning guidance for commissioners of self-harm services, and perhaps the Department of Health could look at doing the same for suicide prevention.

Workers in the field of suicide prevention are dedicated and committed, but isolated. Our inquiries showed the need to share best practice nationally, and in the near future we hope to hold a conference in the House of Commons to facilitate networking so best practice can be shared and so that we do not constantly expect people to reinvent the wheel. We will go back and look later at the effect of the suicide prevention plan for England and the impact of the reorganisation in England.

I mentioned briefly the importance of not linking suicide just to mental health services. The Appleby report of 1999 suggested that 75% of those who commit suicide are not known to services. That is important. We must not always look for a mental health link. If we do so, we will neglect to provide services that address a large number of people who take their own lives.

The debate is important. Suicide reflects on society as a whole. It can affect any hon. Member and any family. As the hon. Member for South Antrim has said, it can affect people whether they are rich, poor, successful, young or old. The sad tragedy that unites them all is that they are lives wasted, and lives we should set out to save.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Dodds]

It is difficult to be too specific, as every individual’s case is different. Undoubtedly, however, one of the biggest factors, particularly in my constituency, is loneliness and isolation, along with drugs and alcohol. That combination, together with the context in which people have grown up, can often become a too powerful and overwhelming set of circumstances with which to cope.

Particular issues, then, arise in Northern Ireland and my constituency, and they might be different from many cases in England, Wales and Scotland. We have this added problem and pressure of coming out of the period of awful violence that we suffered. Only today, as we look back at the research and work done, do people realise that that period was so awful that we are still living with the consequences. Indeed, people are still dying, even today, as a result of what happened in that period. The hon. Member for Beckenham (Bob Stewart) talked about the experience of soldiers—he was right to highlight that—and it applies to people who served in the security forces, too.

On the issue of how this affects family members, I am thinking particularly of a dear lady who had lost a number of her family members, including two children, to suicide. She told me that she feared for other members of her family because of the increasing prevalence of family members copying what other family members or their close friends had done. The problem is exacerbated not only by sites on the web that encourage suicide but even by Facebook, when an insidious form of peer pressure can be applied.

[Mrs Moon]

One big problem is when anniversaries are marked. We must do some work to highlight the risk of anniversaries and the fact that they are not best marked by further deaths. That key piece of work must be undertaken.

[Mr Dodds]

The hon. Lady is absolutely right, and some families have told me that they dread an anniversary coming up. They sometimes sit up for days on end watching over their loved one in case something happens. They are very aware of this problem as anniversaries are approached.

I want to mention the excellent work done by the integrated services for children and young people programme on the Shankill road in my constituency. The Secretary of State for Northern Ireland visited that project just last week, and the shadow Secretary of State, the hon. Member for Gedling (Vernon Coaker), who I am pleased to see in his place on the Front Bench, has also visited the Spectrum centre in the Shankill, and is aware of the great work done by Nicola Verner and others. Immensely important work is being done trying to help families that have all sorts of problems and needs. Intervention at an early stage is carried out, helping and supporting families as youngsters go through school and into the teenage years. Excellent work is being done by many organisations, much of it helped by Government. We just want to see that work consolidated and, if possible, increased.

I am conscious that other Members want to contribute, so I shall make my last point. A number of families raised with me the point that when young people go to an accident or emergency centre or to their GP and are concerned about their state of mind and vulnerability, it would be a good idea for them to have somewhere like a place of safety—somewhere they can go to and be put in contact with others who understand what they are going through. They should not just be given a piece of paper as a prescription and told to come back in a week’s time. They need somewhere to go to where they can talk to people; that is vital. I commend the Minister from the Northern Ireland Department of Health, Social Services and Public Safety for taking this issue on board.

[Mrs Moon]

One of the most helpful developments has been the engagement of the Samaritans in A and E departments. That has really made a difference, especially in self-harm cases. Where the nursing staff might be too busy to give up time, the Samaritans might be able to provide that time and support, which would be an excellent move forward.

[Mr Dodds]

I agree. That shows the importance of the excellent work the hon. Lady does as part of the all-party suicide prevention group to share best practice, as there are bound to be lessons we can learn from each other.

I commend the work that is being done. The Health Minister in Northern Ireland, Edwin Poots, has taken a close personal interest in the issue. He recently held a workshop for workers in the community and voluntary sector, and he has also met a number of family support groups. He has tried hard to raise the profile of this issue. It is now taken very seriously across the board in Northern Ireland—by all the political parties, and in the community and voluntary sector—and I think it important for Members to take the opportunity to highlight it here as well. It is one of the biggest problems that we face, certainly in my constituency.

I commend and thank everyone who has taken part in the debate, and all those, in my constituency and elsewhere, who are dedicated to trying to prevent suicide.

Oral Answers to Questions

Madeleine Moon Excerpts

Tuesday 15th January 2013 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question. The Government take the development of talking therapies extremely seriously and I can confirm that I met Lord Layard yesterday, together with representatives of the NHS Commissioning Board. There will be a central team and we are absolutely determined to keep driving this approach forward, as there is real evidence of results.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?

[Mr Hunt]

I know that the hon. Lady spoke very movingly in the debate on dementia last week and I wholeheartedly agree with her. The medicines available for people with dementia do not help everyone, but we do not know that until we try them. By diagnosing only 42% of people with dementia, as is currently the case, we are denying nearly two thirds of dementia sufferers the chance to see whether they could benefit from those medicines and, as she rightly says, the chance to plan their care, which could mean that they could live at home for much longer.