Tobacco Products (Standardised Packaging)

Mike Thornton Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

Health is, of course, very important, particularly the health of our nation’s children, and I welcome the hon. Gentleman’s support.

[Mike Thornton (Eastleigh) (LD)]

Given that eight out of 10 people start smoking under the age of 19—in their teens—does the Minister agree that one of the most effective child protection measures we can take is to help them not to start smoking in the first place?

[Jane Ellison]

My hon. Friend is exactly right and I believe that all Members want to see fewer children taking up smoking. I also draw the House’s attention to the fact that the places where children take up smoking are very unevenly distributed. On maintaining the Government’s duty on health inequality, which we have put in statute, measures to prevent young people and children from taking up smoking directly address some key health inequality issues.

Care Bill [Lords]

Mike Thornton Excerpts

Tuesday 11th March 2014 Commons Chamber

[Sarah Newton]

In many of our inquiries, we have looked into international collaborations between universities that are tackling some of the greatest challenges of our time. One example is research into various forms of dementia, and proteins in the brain that contribute not only to vascular dementia, but even to vCJD. We have concluded that in order to meet the huge challenges that those diseases pose to the whole world, we need to pool our resources across universities and research communities internationally. There is an increasing number of well-established protocols and sensible ways of reassuring patients and others about the use of their data. Such international collaboration makes it more likely that we can make discoveries that will drive improvements in people’s outcomes.

Frameworks and safeguards exist to enable universities and academics to collaborate. We should be careful about the language that we use in this context, because there has been scaremongering, and people are identifying all sorts of potential uses for the data for which there is not much evidence. We have been reassured several times today that the information would not fall into the hands of insurance companies and be used in a harmful way.

[Mike Thornton (Eastleigh) (LD)]

The hon. Lady is making a strong point. I visited the oesophageal cancer research unit at Southampton hospital. As I am sure all Members know, oesophageal cancer is a particularly filthy disease, and is very difficult to treat. The lack of data made it hard for those in the unit to find out what was going on, and to have more information to work on. I am glad to say that they are getting there—slowly—but I think it particularly important to note that data of this kind can be used to save lives.

[Sarah Newton]

We could spend a great deal of time talking about different types of medical research that are enabling huge progress to be made with particular diseases. Given the time that is available to me, however, I now want to talk about another aspect of the importance of sharing medical data to improve patient outcomes—the integration of social care with NHS services. I am sure that everyone in the Chamber would say that that was a good thing. It is important for all the services in a community, whether provided by a local council or by primary or acute care authorities, to be joined up around patients and their families to ensure that patients receive the best possible care, whatever their long-term condition may be. That is a subject that we all discuss, and on which we largely agree. However, when it comes to practical implementation, what we hear in inquiry after inquiry is that the barrier that prevents the delivery of those joined-up, improved outcomes is a lack of ability to share data.

Care Bill [Lords]

Mike Thornton Excerpts

Monday 10th March 2014 Commons Chamber

In that regard, both Care England, which represents residential care providers, and the United Kingdom Homecare Association have grave concerns about the unintended consequences of some of the measures. When I met UKHCA members in February, they were very clear that below-cost pricing by local authorities was a growing problem. According to Laing and Buisson, English councils are paying £480 on average for residential care, although the assessment of a fair market price was about £651. The issue concerns the use and abuse of monopsony power in a financially challenged market. It also relates to new clauses 7 and 9, which I will come on to in a moment.

[Mike Thornton (Eastleigh) (LD)]

My right hon. Friend mentions Laing and Buisson. I believe that it has come up with a formula that should enable people to work out a fair funding system in advance. Is that something we could look at?

[Paul Burstow]

My hon. Friend is absolutely right. That is the basis of the average fair rate, which I mentioned. New clause 15 would provide a mechanism for establishing a formula by which fee rates are set transparently for both domiciliary and residential care. The organisations representing the sector believe that that would lead to much greater transparency, and I think that it would deal with some of the rather toxic relationships that sometimes appear to exist, both nationally and locally.

New clause 2 is about older people, particularly the proposition that we should take a leaf out of the book of our colleagues in Wales and Northern Ireland in relation to having a commissioner for older people. Ageism and ageist attitudes are endemic in our society and, indeed, in public services. Our society is ageing, with life spans increasing, and that profound change will affect us all. It has implications for how the NHS and care services behave, but it goes far wider.

My new clause simply calls on the Government to work on the mechanics of establishing such a post so that there is someone to listen to and give a voice to older people; to champion their vital contribution to our economy—in work, as care givers and as volunteers, mentors and community leaders—rather than their being seen as burdens, which is how older people are all too often portrayed; to challenge the complacent and lazy stereotypes; and to hold public services to account.

Such a role already exists in Northern Ireland, Wales and other parts of the world. It would involve asking such questions as: why do the 360,000 cases of abuse suffered by older people every year lead to so few prosecutions, why are older people excluded from clinical trials and other research, and why do we stop reporting people’s cancer survival rates once they pass the age of 75? I hope that the Minister is open to the idea, and I look forward to his response.

New clause 26 deals with the issue of mental health, which came up very briefly in Committee. I know that the Minister is a passionate champion of mental health concerns. The new clause simply says that if a person has an accident—for example, breaks their arm—suffers a stroke or has a heart attack, the last place they would expect it to be sorted out is a cell in a police station, but that that is exactly where people who have a mental health crisis find themselves. The statistics are stunning: 36% of all people who are taken to a place of safety find themselves in a police station and stay there for more than 10 hours. Not only have adults been subject to that process, but 263 children, on the most recent figures. My new clause simply seeks to place a sunset provision on the definition of a place of safety, including a police station, which should create a way of concentrating minds to ensure that services are provided in the right place at the right time for children and adults.

I come to new clauses 7 and 9 last because they are about addressing what we might regard as the elephant in the room in any conversation about care services and the Bill’s noble intentions of improving the quality of care and of driving well-being into the heart of how care and support are delivered. The new clauses raise interconnected questions about the future funding of care and support, and about the independent nature of our health and care systems. Social care has for far too long—for decades—been the poor relation to health in decisions about public expenditure. Today’s funding challenges are chronic and are not simply the result of deficit reduction.

New clause 9 reflects the concern of a remarkable coalition of interests outside this place, including the Local Government Association, the Care and Support Alliance, hundreds of non-governmental organisations, directors of social services and chief executives, and many more besides. They all want to serve notice on the Government that they are concerned about the serious impact that the continuing pressure on local government spending will have on the ability of councils to deliver the care and support that everybody in this House wants to be delivered under the Bill. The picture is complex. Different councils are coping differently—some are overspending their care budgets and some are underspending them—but the trend is clear, despite the extra £7.2 billion that was allocated in the 2010 spending review and the transfer of money as part of the better care fund in the most recent spending review.

New clause 9 simply provides for an assessment to be made and signed off by the programme board that oversees the implementation of the Bill. It is not an unreasonable request that we check that the sums add up and that the money is sufficient to deliver what the Bill is about. I hope that the Minister will reassure us about how transparent that process will be. Impact assessments are one thing; this process would be another. I think that it would provide considerable reassurance to those who will have the job of implementing the legislation.

Roaccutane

Mike Thornton Excerpts

Tuesday 3rd December 2013 Westminster Hall

[Sir Nick Harvey]

I entirely agree that a great deal more research is needed. My point in raising the matter with Government through my hon. Friend the Minister is that I cannot see who other than a public authority could initiate or, indeed, fund such research. It is certainly not in the manufacturer’s interest; Roche clings to the notion that millions of people have been treated with the drug without side effects or mishap. That may be perfectly true, but it does not alter the fact that, for those who have suffered a serious side effect, the impact has been devastating. I ask again: where is the precautionary principle?

[Mike Thornton (Eastleigh) (LD)]

What is Roche’s answer to the fact that the drug is more or less banned in the United States—one must sign a separate declaration—and that it is banned in other countries? If the drug is totally safe, why do other countries not consider it so?

[Sir Nick Harvey]

What has happened in the United States is interesting. As we know, the United States has a much more litigious culture than we do in the UK, and the manufacturer there has paid out to a patient on quite a large scale. That patient suffered different side effects, but the manufacturer nevertheless had to pay out. That, combined with the fact that generic versions of the drug are now available on the US market, has caused the manufacturer to withdraw altogether from the US market.

While we are discussing the attitude of Roche, it is worth noting that the information in the drug’s packaging includes explicit warnings about the possible psychological side effects, including incidences of suicide. If Roche acknowledges that to the extent of being willing to put it on the information, it seems to be recognising that for all the millions who may have used it successfully, a cohort of the population has nevertheless suffered as a result of using the drug.

The logical continuum of that is the ultimate withdrawal of the drug altogether. Rationally, I do not think that we can ask the Government to move straight to that in one go, much as I would like them to. Were they to attempt to go down that path, in no time at all they would find themselves locked in some sort of litigation with Roche, which would certainly not stand by and watch a major market like the UK ban its product. The court would expect the Government to demonstrate overwhelming scientific evidence, which I do not believe is available as yet. That is why, as a first step, I am calling for such scientific research to take place.

--- Later in debate ---

[Sir Nick Harvey]

My hon. Friend makes an interesting point, and I am sure that he is absolutely right in his belief that if it were mentioned in the warning notes, the use of the drug would undoubtedly be greatly reduced, as we would want in the interim.

Let us look at the available scientific and anecdotal evidence that establishes a link between the drug and the effects that I have described. Roaccutane is a vitamin A-related compound that has long been known to cause psychiatric side effects. Reports of users experiencing depression have continually surfaced, so much so that in the USA the Food and Drug Administration forced Roche to produce safety warnings about Roaccutane as long ago as 1998. The following year, an Irish study found that users of the drug were 900 times more likely to suffer from depressive symptoms than patients being treated for acne with antibiotics.

Although many studies since that time have provided limited evidence, they have often been too small to be viewed as conclusive. However, I want to mention two that stand out. First, in 2005, Dr Doug Bremner from Atlanta university published a study using brain imaging before and after four months of treatment with Roaccutane. The images clearly showed an impact on brain function, associating the drug with a decrease in function of the frontal lobe—a part of the brain that regulates emotion. Secondly, Dr Sarah Bailey from Bath university undertook studies on young adult mice and rats. When the animals were put through a “forced swim” test, where they were placed in water, those on Roaccutane spent longer being immobile, without attempting to escape, than those on antibiotics—a change in behaviour consistent with depression-related behaviour in the animals. Of course, humans and mice are very different and therefore much more research is necessary. However, at the very least Dr Bailey’s findings should be seen as a caution to doctors prescribing the drug.

These studies simply are not enough. It is evident that not everyone who takes Roaccutane develops depression, but there is clearly a vulnerable population of patients who do. Investigations just have not gone far enough to find out why that group is vulnerable, but such research is vital. Surely, before we lose more young lives to the psychological impact of the drug, there is a clear case for further study on a larger scale.

Roche consistently says that it does not know the mechanism by which the drug actually works. Therefore, one might conclude that it is none the wiser about, or perhaps is not interested in, how these side effects work. However, one cannot ignore the fact that isotretinoin—I cannot pronounce it properly—is the only drug not designed to affect mental state that features in the USA’s top 10 list of drugs associated with depression. In response to the idea of a link between Roaccutane and depression, many people have suggested that the victims were already depressed because of their acne. While acne may indeed reduce self-esteem—many acne sufferers will know what I mean by that—it is an exaggeration to generally describe people who suffer from acne as being in the grip of depression.

[Mike Thornton]

That description just sounds ridiculous. Surely, if this drug is effective at curing acne, if someone took it and their acne was cured, they would not be depressed by having acne because their acne would have gone. There is no way acne could be described as being the cause of the depression.

Psychological Therapies

Mike Thornton Excerpts

Wednesday 16th October 2013 Westminster Hall

[Mike Thornton (Eastleigh) (LD)]

I am glad to follow my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) and the hon. Member for Strangford (Jim Shannon), whose points were particularly relevant. I shall try not to repeat them too often in my speech—that might mean reducing its length slightly, people will be pleased to hear.

When I was first elected, a new aspect of my life was the size and complexity of the casework that came my way. Much of it I expected and was familiar with, having been a councillor, but the one facet that surprised—no, shocked—me was the obvious failure in our duty to those with mental health issues. The next surprise was to discover that, in fact, the situation has improved over the past few years, and for that I pay tribute to the Minister, my hon. Friend the Member for North Norfolk (Norman Lamb), and his predecessor, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow).

Today, we have the news that Dr Martin Baggaley, commenting on the results of a BBC freedom of information request, said that we are in “a real crisis” regarding the provision of mental health beds in England. My hon. Friend the Member for North Norfolk, the Minister, is reported by the BBC to agree that that is unacceptable.

At least, however, the BBC was able to obtain figures for the number of beds that have been lost. What would the response have been had the local trusts said, “Sorry, we don’t keep such figures. We have no idea of the number of beds available”? In another possible scenario, one of us asks the Secretary of State for Health, “What is the waiting time for the treatment of breast cancer or leukaemia?”, but the answer is, “I don’t know and I can’t find out.” Would not the whole House erupt in outraged uproar? Would not the press ask how proper provision for those patients can be provided in such circumstances?

Without adequate data and reporting, the needs of millions of ill people cannot be addressed—people with mental health issues. Without decent information, resources cannot be allocated correctly, results properly analysed or effective treatment provided. Yet for much of mental health provision, there is insufficient knowledge of whom we are treating, how we are treating them and how long they are waiting for treatment. As my hon. Friend the Member for Halesowen and Rowley Regis mentioned, we do not have minimum waiting times for much psychological therapy.

Few data are collated for the national policy framework. The data that we have focus on IAPT services and the rates for early mortality. My hon. Friend mentioned how early treatment of mental health problems can stop far worse developments, but without proper data we cannot understand that.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The hon. Gentleman is making an important point about early intervention in mental health conditions. Does he agree that early intervention does not just stop an individual from cascading to the point at which their life becomes dysfunctional, but has a tremendous economic impact in preventing time off work and the difficulties that that causes for employers?

--- Later in debate ---

[Mike Thornton]

I agree. There is no doubt that early intervention for all forms of illness usually produces good results, and saves large amounts of money both in relation to rates of people off work and the costs of treating them in the NHS. That can be seen for cancer and heart failure, as well as mental health issues, so I entirely agree with the hon. Lady.

In my constituency, I have been particularly impressed by Solent Mind’s talking therapy programme. That IAPT programme has been effective and easy to access, and figures show that it has provided access to a huge majority within 28 days of a referral. I am not sure whether that is replicated across the country; I have been told that probably it is not.

Such IAPT services are invaluable, but there are disturbing reports that funds are provided for them with money taken away from other mental health provision. My hon. Friend the Member for Halesowen and Rowley Regis mentioned some examples, so I will not repeat them, but it is a bit like increasing funds for bowel cancer care by taking cash from ovarian cancer treatment. I wonder if this morning’s BBC report reflects what is happening in beds being lost to provide money for other therapies and services.

Public Health England and NHS England have announced the development of a mental health intelligence network, which has the potential to link all existing data and map data gaps. However, given the consistent failure to give mental health provision the same status as that for so-called physical health, there is a real risk that the network will not have the resources needed to provide the data and analysis that are so urgently required.

If we are to provide adequately for the one in four of us who suffers from some form of mental illness and for their families who suffer with them, I urge the Minister to ensure that all local commissioning groups and trusts treat information regarding all forms of mental illness with the same parity of esteem as that relating to physical illnesses. I again urge Members to remember that if someone is ill, they are ill. There would be no such lack of data if the absurd, anachronistic and artificial distinction between physical and mental illness did not exist.

Oral Answers to Questions

Mike Thornton Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr Hunt]

What I can guarantee is that there will be a real-terms increase in the public health budget for all local authorities under a two-year settlement, which they did not have before. I hope that the information that was published this morning, which shows how cities that are comparable to Liverpool are managing to get better health outcomes, will help the local authority in Liverpool to improve its results.

[Mike Thornton (Eastleigh) (LD)]

11. What progress he has made in delivering parity of esteem between mental and physical health.

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

One of NHS England’s objectives is to ensure that mental health and physical health are given equal priority. By March 2015, we expect the NHS to demonstrate measurable progress towards achieving parity of esteem, so that everyone who needs them has timely access to evidence-based services.

[Mike Thornton]

Freedom of information figures that were obtained by Mind from Southern Health NHS Foundation Trust reveal that in my constituency, the number of people with mental issues who are admitted to hospital, rather than treated by specialist crisis resolution and home treatment services, is higher than average. What steps is the Department taking to ensure that everyone has access to mental health crisis care services that provide alternatives to hospital admission?

[Norman Lamb]

I applaud the work that Mind is doing to demonstrate the stark differences between the treatment of people with mental health problems who are in crisis and that of people with physical health problems. Its work demonstrates that without proper liaison services, people end up in hospital, at increased cost to the NHS. I have asked all the relevant bodies to get together to agree a plan to ensure that there is urgent crisis care for people with mental health problems, like that experienced by people with physical health problems.