Gay-to-straight Conversion Therapy

Mike Freer Excerpts

Wednesday 20th November 2013 Westminster Hall

[Sandra Osborne]

Thank you, Mr Hood.

I want to focus on the main aspects of the problem of conversion therapy, and to debunk three common myths: first, that conversion therapy is something that happens only in America; secondly, that conversion therapy is carried out only by religious fundamentalists operating outside professional channels; thirdly, that the debate about conversion therapy is a simplistic one between allowing people freely to choose conversion therapy and infringing people’s personal choices. On the contrary, I hope to show that conversion therapy is a real and present danger in Britain, and that instead of being a problem just among religious fundamentalists, it is an issue for the national health service and the professional sector. This is not a simplistic debate about freedom to choose. If lesbian, gay, bisexual and transgender community patients are coaxed into undertaking therapy by peer pressure or referred to conversion therapists after approaching professionals, that is hardly free choice.

[Mike Freer (Finchley and Golders Green) (Con)]

Does the hon. Lady agree that until now the Department of Health has been weak on the matter? Instead of condoning it, it should ban the voodoo medicine and conversion therapy.

[Sandra Osborne]

I agree with the hon. Gentleman and I hope to get some answers from the Minister.

Conversion therapy used to be a much greater and more systemic problem in Britain than it is today. In the 1950s and ’60s, LGBT patients were routinely forwarded by teachers, GPs and, as in the case of Alan Turing, criminal courts to NHS so-called specialists in sexual orientation treatment. During that period, all branches of psychology from the cognitive to the behavioural and the psychodynamic had their own cruel and unpalatable methods of dealing with same-sex attraction.

The watershed moment came when homosexuality was removed from the American “Diagnostic and Statistical Manual of Mental Disorders” in 1973. However, simply changing the rules does not change an entire system overnight. Conversion therapy persisted and psychotherapy remains an unregulated profession in Britain. Anyone in the country can set up as a psychotherapist without being part of a professional body, and there are professionals practising in the NHS and therapy sectors who received their training well before homosexuality ceased to be classed a mental illness. Even the new intake of therapists is a cause for concern.

In 2008, a survey of 226 British psychology undergraduates was published in the Journal of Homosexuality and found that only 66% agreed with an equal age of consent. That is the context in which we should view the extent of conversion therapy in Britain. In a 2009 survey of more than 1,300 accredited mental health professionals, nearly 300 willingly admitted to having attempted to change at least one patient’s sexuality. Even more shocking, the therapists admitted that some 35% of the patients they treated were referred to them for treatment by GPs, and 40% were treated inside an NHS practice.

HPV Vaccine

Mike Freer Excerpts

Tuesday 2nd July 2013 Commons Chamber

[Mike Freer (Finchley and Golders Green) (Con)]

I am grateful to Mr. Speaker for granting me this debate on vaccinations against the human papillomavirus, otherwise known as HPV. My main aim is to raise the issue of the inherent inequality of the vaccination programme, which excludes men.

Discussing this issue involves raising topics that people often do not want to talk about, but such discussion is easier than having to deal with the illnesses and diseases that arise from not vaccinating. Embarrassment is preferable to the many cancers that are associated with HPV.

Let me begin by saying that it is important to acknowledge the success of the programme. Since its launch in 2008-09, it has successfully screened and vaccinated more than 80% of applicable girls. Last year the original HPV vaccine was replaced with the quadrivalent HPV vaccine, which provides protection against the two strains of HPV that cause at least nine in 10 cases of genital warts. Of course this added protection is above the primary purpose of the vaccination programme—to bring down rates of cervical and vaginal cancer in women. Men are, however, up to six times more likely than women to have oral HPV infection, thereby increasing the risk of cancers of the throat, neck and head.

[Mr Mark Spencer (Sherwood) (Con)]

I am pleased to hear my hon. Friend mention throat cancers in men. Will he address how much the treatment of such diseases would cost compared with the cost of the vaccine?

[Mike Freer]

Yes, I will raise the cost-effectiveness of the vaccine as compared with the treatment costs of many cancers, including oral or pharyngeal cancer, which is throat cancer.

In 2009, just after the HPV vaccination programme started, there were over 6,500 cases of these cancers, with 47% of penile cancers and 16% of head and neck cancers thought to be HPV-related. Today, however, overall rates of HPV-related cancer and warts should—should, I stress—subsequently come down in heterosexual men, because of so-called herd immunity.

Herd immunity is where men have sex with vaccinated women and thereby get protection against warts, as well as other cancers including penile, anal, oral and pharyngeal cancers. However, they get such protection only if they have sexual contact with UK-born women who have been vaccinated, or with Australian women or those of the very few countries that have had a mass vaccination programme.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate. Does he agree it might be better if we had a regional vaccination programme not only for England and Wales, but for Scotland and Northern Ireland as well, so we can address issues of education and intervention UK-wide first, and also globally?

[Mike Freer]

The hon. Gentleman makes a good point. On a small island such as ours it is important that men who are having sex with women, or men having sex with men, are having sex with partners who are vaccinated, and I believe that is a matter not just for England and Wales, but for the whole of the United Kingdom, and we would also then be setting an example for the rest of the world.

Herd immunity is valuable, but it is not foolproof for heterosexual men. I have mentioned that it is valuable where heterosexual men are having sex with vaccinated women, but men who have sex with men are not subject to herd immunity, and that is another element of inequality. Evidence from other countries suggests herd immunity will eventually prevent most, but not all, cases of HPV-related cancer in heterosexual men. There is still work to be done, therefore, on all men having vaccinations against HPV-related cancers.

Some HPV-related cancers are on the rise in the UK, despite the vaccination programme. Throat cancer has overtaken cervical cancer as the leading HPV-related cancer in the UK. Men who have sex with women who are not vaccinated remain at risk. This is of concern to men who, for example, have sex while on holiday or while living outside the UK, or who have sex with unvaccinated migrants to the UK—but men, straight or gay, remain at risk.

The current programme is inequitable, as those men who “stray from the herd” by having sex with unvaccinated women or men will remain at risk. That is why I am seeking a commitment for the HPV vaccination programme to be widened.

The key issue I wish to press is the health inequality in respect of gay men and anal cancer, an inequality perpetuated by the current vaccination policy. Gay men already experience poorer sexual health as a group; they are at an increasing and far higher risk of HIV and other sexually transmitted infections compared with the wider population. Rates of anal cancer in gay men are now equivalent to those for cervical cancer in women before the cervical cancer screening programme was introduced in 1988. HPV is associated with 80% to 85% of anal cancer in men, yet it is not yet possible to screen for or effectively treat anal pre-cancer, as it is for cervical cancer; HPV vaccination is the only effective form of prevention, and it is being denied to men.

Gay men with HIV are particularly susceptible to HPV-related anal cancer and as the number of gay men with HIV continues to rise year on year, so will cases of anal cancer, other HPV-related cancers and warts. In addition to having a disproportionate effect in HIV-positive men, HPV can increase the risk of HIV transmission. HPV can increase skin fragility and overt anal warts can bleed, which enhances the risks of acquisition or transmission of HIV infection. This health inequality between gay men and the general population will continue to widen as long as gay men remain unprotected against HPV. I stress this point as it relates to gay men, but it also affects heterosexual men who are equally unprotected.

[Pamela Nash (Airdrie and Shotts) (Lab)]

I congratulate the hon. Gentleman on making a powerful argument on a difficult subject. Michael Douglas, the actor, was given much criticism in the press recently for talking about these difficult issues. I know about this, because I had the HPV vaccine as a 17-year-old, so I am glad the hon. Gentleman has brought the matter to the Floor of the House. I just want to highlight the fact that this is an issue not only for homosexual men in terms of the vast health inequalities they have here in the UK, but for heterosexual men. Although we have a successful HPV vaccination programme for young women, we by no means have the whole herd vaccinated just yet.

[Mike Freer]

The hon. Lady makes a good point. Herd immunity is valuable only for those who are sleeping within the herd. Those who have sex outside the herd are at risk, and that inequality needs to be addressed.

The best way to protect all males against HPV-related cancers and warts would be to offer the vaccine to all boys aged 12 to 13, as well as girls, as part of the school-based immunisation programme. The vaccine is most effective when given at this younger age, before people start having sex and before exposure to the strains of HPV. Other countries are starting to do that; the vaccine is available for boys in a number of other countries, including Australia and the United States. I firmly believe that we should follow suit.

If we do not have a widespread vaccination programme for boys, at least, and as a bare minimum, gay men should be offered the vaccine when they first present at a sexual health clinic as men who have sex with men. That would match the current policy on offering hepatitis B vaccinations to gay men. Given the expense of treating HPV-related cancers and warts, there is a strong cost-effectiveness argument for extending the availability of the HPV vaccine. If the inequality is not a powerful argument, the cost savings to the Department of Health must be.

The Joint Committee on Vaccination and Immunisation inquiry that began last year is welcome, although little is known of the progress it is making. If the JCVI looks into the cost-effectiveness of vaccination initiatives, it will find that the case to extend the programme to boys is irrefutable.

Each HPV vaccination for the three-dose programme costs £260. Compare that with the lifetime treatment and care cost of an HIV-positive man or woman at £280,000 a year, the £13,000 cost of treating anal cancer, the £11,500 cost of treating penile cancer, the £15,000 cost of treating for oropharyngeal cancer or the £13,600 cost of treating vulval and vaginal cancer transmitted by an infected male. In 2010, the cost of treating anogenital warts was £52.4 million.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I congratulate the hon. Gentleman on securing the debate. If the Minister and the Department are considering reviewing the vaccine in the light of his speech, may I ask the Minister whether she will also consider another aspect of this—that is, the number of young women who have had a severe adverse reaction to the vaccine? My constituent, Stacey Jones, received the vaccine five years ago and since then she has struggled with memory loss, loss of concentration, mood swings and a need for continuing treatment by the neurology department at the Queen Elizabeth hospital in Birmingham. Does the Minister accept that it cannot be an acceptable price to pay for what might be an otherwise beneficial vaccine programme if some young women undergo such a severe reaction? Will the Minister and her officials look into this to see how many other young women are in that position and whether changes can be made to reduce the number of young women who have had such a reaction or even stop it altogether?

[Mike Freer]

I am grateful to the right hon. Gentleman for intervening on me to ask the Minister a question and I am sure that she will answer it in due course. He makes a valuable point, however. I, too, have a constituent who had an adverse reaction to the vaccine and who is believed to have myalgic encephalomyelitis as a result. Statistically, such reactions might only be small in number compared with the benefits of the widespread vaccination programme, but he makes a good point in that it is important that the Department of Health tracks them to see whether a pattern emerges over time.

[Mr Spencer]

My hon. Friend is being very generous with his time. Is screening available on the NHS to prove whether someone is a carrier of HPV? If I presented myself to my local GP and asked to be screened, would such screening be readily available?

[Mike Freer]

To be honest, I am not sure that I can answer the question. I suspect, however, that if my hon. Friend presented at a sexual health clinic, the staff might be able to advise on what screening or tests were available to identify whether he is a carrier of HPV. It is quite common in men, so in all probability he is. He might want to visit a sexual health clinic tomorrow—if I have not frightened him too much.

I understand that the JCVI inquiry is limited to considering cervical cancer, which restricts the review to women and girls. I press my hon. Friend the Minister to confirm that the JCVI’s scope will be extended to include all HPV cancers so that we can look at how best to vaccinate boys, girls, women and men. The Department of Health must redefine the formal aim of the programme, because if it does not it will be compounding inequality and cost-ineffectiveness.

Males must be protected against the four strains of HPV. The herd immunity that will potentially result from the current programme is often used as a defence for not vaccinating boys, but that implicit intention of excluding men who have sex with men or men who have sex with women who are not vaccinated is simply not sustainable.

The inequality of health protection is obvious and so are the cost savings that I have identified. I know that the Minister will be as concerned as I am that that cost-ineffectiveness and inequality cannot be allowed to continue, and I look forward to hearing her confirmation that the scope of the review will be widened.

--- Later in debate ---

[Anna Soubry]

I am grateful for that intervention. I was about to conclude by saying that it is only fair and right to acknowledge the powerful arguments that have been advanced by a number of hon. Members this evening. They have certainly caused me to take the view that I will not hesitate to contact the JCVI, as a matter of urgency, to raise all these important points with them. The committee is an independent expert body, and when it gives its advice to the Government, the Government are—quite rightly—bound to accept that advice.

[Mike Freer]

I am grateful to my hon. Friend for the commitment and the confirmation that the JCVI is now looking at this, but while we are waiting for 2014 and the results, can my hon. Friend confirm, if not tonight then in writing, that the Department of Health will give some guidance that sexual health clinics and GUM clinics can offer the vaccinations as an option before that becomes mandatory, should the JCVI recommend that?

[Anna Soubry]

I had thought that that was already the situation; but if I am wrong, I will not hesitate to agree to a quite proper, reasonable request. I think that I am wrong.

[Mike Freer]

My hon. Friend is being very generous. May I confirm that the vaccination is available only to men on private health schemes and that they have to pay for it?

[Anna Soubry]

Forgive me—it is available, but people have to pay for it. The point being made is that they should not have to pay for it. It should be available, like any other vaccination. That is a good point, and one that I am more than happy to take up.

These are all important and powerful arguments, especially when they are advanced on the basis of inequality, which should concern us all, wherever it may lie, and a good argument has been made that it is simply not fair on men who have sex with men that they should not have the same sort of protection as heterosexual men. If for no other reason, that demands that I make further inquiry.

I repeat—I am sorry to have to repeat it—the committee is an independent body, but it has such force and power that when it makes a recommendation, there is no debate or argument about it: the Government follow its recommendation. I am more than happy to take the matter forward and to make sure also, which is very important, that the committee’s recommendations and findings are made as soon as possible. At present, I am told that that will be in 2014 at the earliest, but it seems to be the sort of matter that requires everybody’s most urgent attention. I hope that is a positive note on which to finish.

Question put and agreed to.

Mental Health

Mike Freer Excerpts

Thursday 16th May 2013 Commons Chamber

[Mike Freer (Finchley and Golders Green) (Con)]

One of the first mental health cases that I came across was that of a wife and mother who had been subjected to repeated rape by an invading force. She was a refugee in this country. It was a tragic case. Although the physical manifestations of the ordeal had healed, the mental manifestations continued a decade on. She could not function either as a woman or as a mother and wife. That case drove home to me that many of the mental health issues that we face in this country are ignored simply because we cannot see them. That is reflected in the funding priorities in the NHS.

Two issues have come to my attention recently through my casework: the speed of treatment and the consistency of care. One of my constituents had to wait for many weeks to be referred to a psychiatrist. She was able to cope with that, but every time she went to see the psychiatrist for an appointment, she saw a new psychiatrist and had to repeat her case history. Although the notes may have been there, the new psychiatrist either had not bothered to read them or wanted the patient to repeat the details. That was disruptive to the treatment.

My second constituent was a young teenager who grew up being treated for an eating disorder in a residential unit. I see that my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) has returned to her place; I heard her powerful comments. When my constituent turned 18 or 19, she was no longer suitable for the facility that she was in. She had to fight for a new facility, with the help of her parents. When she eventually got into a new facility, it was not in the same place or with the same clinicians. That disruption of care and change in setting set her and her family back a huge amount.

No matter what I did, I could not make the mental health trust realise that sometimes the rules are there to be broken, or at least bent, if the mental health of the patient would benefit from continuity. Continuing my constituent’s care when she was 19 or 20 might not fit the rules, but it fitted the patient. I gently ask the Minister whether there might be some service-level agreements on allowing flexibility in provision.

The NHS website on improving access to psychological therapies does not mention service standards, consistency of clinical care or speed of referrals. The website of the Barnet, Enfield and Haringey Mental NHS Trust mentions a named care co-ordinator, who I assume is an administrator, but there is no mention of clinical standards or continuity and speed of care.

I realise that this is a complex issue and that there are no easy solutions, but I gently ask the Minister whether the Department of Health will consider publishing guidance on speed and continuity of care because it would benefit my constituents greatly.

Oral Answers to Questions

Mike Freer Excerpts

Tuesday 15th January 2013 Commons Chamber

[Norman Lamb]

I am very much aware of the situation in London, and I acknowledge that some good work has already been undertaken there. Local authorities are very much aware of their responsibility that will apply from April and are already working with clinical commissioning groups in London to ensure that comprehensive services are in place for the London community.

[Mike Freer (Finchley and Golders Green) (Con)]

Pan-London preventive health care is important, but with the devolution of funding to local authorities, there is a great risk of them refusing to pool funds and of preventive health programmes in London collapsing. Can the Minister reassure Londoners that pan-London programmes will continue?

[Norman Lamb]

Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.

NHS Risk Register

Mike Freer Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mike Freer (Finchley and Golders Green) (Con)]

The issues underpinning the debate are purely ideological, and no amount of amendment—[Interruption.] Exactly. It is not about making the NHS better; it is about purely ideological opposition to reform.

[Richard Graham]

I am very grateful to my hon. Friend for giving way, which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) did not do.

Does my hon. Friend agree that the speech we have just heard from the right hon. Gentleman had nothing whatsoever to do with the motion under discussion? He did not mention the NHS risk register once, except to say that it was a “secondary issue”. To all the rest of us here, it is “the” issue under discussion. Was not the right hon. Gentleman’s speech simply a whitewash of his own time as Secretary of State for Health?

[Mike Freer]

My hon. Friend has made a very good point. The issues that have been raised have nothing to do with the risk register. This is simply a new stick with which to beat the Government. No amount of amendment and no amount of rational argument will appease those who are simply philosophically opposed to reform of the NHS.

[Jack Dromey]

Will the hon. Gentleman give way?

[Mike Freer]

I will give way later. I want to make a little progress first.

I do not believe that the Opposition’s call for publication is remotely to do with transparency. If it were, they would themselves have published risk registers in the past. The right hon. Member for Leigh (Andy Burnham) said earlier that the present was not the same as the past, and that the past had not involved major reorganisations. Let me refresh his memory. In 2008 and 2009, in London, there was a major reorganisation of hyper-acute stroke units and a major reorganisation of major trauma centres. When the clinicians and the public opposed that action, what did NHS London do? It did not make the risk register public; it did not make details of all the risks fully available so that we could make an informed judgment, as the Opposition are trying to persuade us to do. It simply rewrote the consultation results, and what did it say? “The consultation results from the people of Barnet were inconvenient, and we are therefore inserting a new chapter so that we can ignore the clinicians and the patients.” That is the track record of the Labour party.

The Opposition may come to regret—

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will the hon. Gentleman give way?

[Mike Freer]

I said earlier that I would give way to the hon. Member for Birmingham, Erdington (Jack Dromey).

[Jack Dromey]

I am grateful to the hon. Gentleman. When he stood for election and went to the good people of Finchley and Golders Green—the doctors and the nurses in the constituency that he now represents—did he say to them, “Vote for me, and we will undertake a top-down reorganisation of the national health service”?

--- Later in debate ---

[Mike Freer]

I will tell the hon. Gentleman what I did say. When I met GPs, I said that I would support putting patients first. Moreover, reform of the NHS was clearly specified in the Conservative manifesto on which I stood.

The previous Government sought to involve the private sector. Where was the risk register then? Was it published when the private sector was involved in the NHS? No, it was not. Will we get to see that risk register now? I doubt it.

Risk registers are, by definition, meant to explore everything that could possibly go wrong. They never make happy reading. The Secretary of State has already published more information than has ever been published before. He has already published relevant risks connected with the Health and Social Care Bill in the combined impact assessments, which consist of 400 pages of detailed analysis. The Opposition see the release of the risk register as simply an opportunity to cherry-pick the doomsday scenarios that it may contain. It is no more than a charter for shroud-waving. Every risk register contains such scenarios, and opponents would present them as fact.

I oppose the publication of risk registers because it would be impossible to pick and choose which were to be published and which were not. Once the Pandora’s box has been opened, it is open. The Opposition may argue that the publication of this risk register is in the public or the national interest. No doubt Department of Health risk registers examine what could go wrong, as in the case of other threats. What about threats relating to terrorism or outbreaks of infectious diseases?

[Clive Efford]

Will the hon. Gentleman give way?

[Mike Freer]

I have already given way twice.

There are clearly good reasons why the details of such threats should not be open to public scrutiny. Some might argue that their publication too is in the public or national interest, but we are not hearing that argument today; we are hearing only about this register, and not about the others. The Opposition’s stance is strong on opportunism and weak on intellectual coherence.

Let us look at their record in government. In 2009, when the shadow Health Secretary was Health Secretary, he refused a freedom of information request for publication of the Department’s strategic risk register. According to the Department,

“'a public authority is exempt from releasing information, which is or would be likely to inhibit the free and frank provision of advice or the free and frank exchanges of views for the purpose of deliberation'”.

There was also reference to the neutering of the free exchange of opinions between Ministers and advisers. That held then, and it holds now.

There is another issue, which was touched on by my right hon. Friend the Secretary of State. If the Department of Health is forced to issue all risk registers, what about other Departments? Will the Treasury have to release all risk registers involving the economy? Would that not cause financial havoc in the international markets? That explains why past Administrations have also refused to publish such documents. From a governance perspective, the Government’s stance is entirely right.

One of the problems of risk registers is that they are meant to be frank about what could go wrong. Any Member who has served on a project board will know how valuable such registers can be and how invaluable completely blank ones can be, and will also know that if the authors of risk registers are afraid to be open because of what might be misinterpreted, routine publication will cause them to become bland and anodyne and will render them useless.

The motion is simply posturing at its worst, and I will be voting “No” this evening.

Oral Answers to Questions

Mike Freer Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Lansley]

I cannot tell the hon. Lady precisely why that proposal has been made, but I will investigate and write to her. Increasing resources overall for the NHS does not mean that everything will stay the same in every particular. There will be change, including the redirection of resources towards providing services in the community rather than in hospitals.

[Mike Freer (Finchley and Golders Green) (Con)]

T5. Occupational therapists are crucial in effective rehabilitation. Will the Minister advise me on what role he sees for occupational therapists in using the £70 million investment in reablement announced by the Government?

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful to the hon. Gentleman for drawing attention to the Government’s commitment to develop reablement services, especially the win, win, win that they can deliver for the individual who gets back on his feet, gets his confidence back and leads his life independently; for the social services departments, which do not have to provide ongoing support; and for the NHS, which does not have to deal with readmissions. Occupational therapists have a vital role to play in providing good quality support following discharge and are therefore critical players in the development of reablement services around the country.