Oral Answers to Questions
Nadine Dorries Excerpts(5 years ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
By 2023, an additional £2.3 billion a year will flow into mental health services across England. Our long-term plan for that increased investment will ensure that more adults, children and young people than ever before are able to get mental health support when they need it. Increased funding will also support further improvements in quality of care and patient experience.
James Cartlidge
I welcome my hon. Friend to her position. My right hon. Friend the Secretary of State will be more than familiar with the long-running problems at the Norfolk and Suffolk NHS Foundation Trust, which is our county’s main mental health trust. There is a huge effort to try to improve it, but I know from constituency cases that significant problems still exist. Will Ministers update us on what progress they think has been made at NSFT?
Ms Dorries
My hon. Friend works tirelessly on his constituents’ behalf. In fact, I think I am meeting some of his constituents tomorrow. I will look into the issues he raises, but the trust has been working since May 2018 on delivering the immediate improvements suggested by the Care Quality Commission, and leadership support has been provided by East London NHS Foundation Trust. I promise to look into the situation to see where the trust is at this point and what improvements have been made, and I may have that information to feed back to him tomorrow.
Jack Lopresti
I welcome the Minister’s recent announcement of greater support for people affected by the suicide of a loved one, but what form will that additional support actually take?
Ms Dorries
It goes without saying that anyone affected by a friend or family member taking their own life will be absolutely devastated. We made an announcement at the weekend of nearly £1 million of funding to target 10 areas to help to provide assistance and support to the bereaved. We will assess those 10 sites to see what is delivered and how it works, and we will hopefully be able to roll the scheme out across the UK in the future.
Dr Paul Williams (Stockton South) (Lab)
I refer the House to my entry in the Register of Members’ Financial Interests. The time in a woman’s life when she is most likely to struggle with her mental health is when she is pregnant or shortly after delivery, but half of all women with depression during that period say that their problem remains unidentified by the NHS. Does the Minister think that it is time for all women to get a postnatal check from their GP as part of the GP contract?
Ms Dorries
We are looking into that. Perinatal support is provided to women across the UK. We have been pushing this from the Department. The hon. Gentleman is absolutely right that this is a time in a woman’s life when she may suffer from poor mental health or a mental health condition that is directly related to her pregnancy, and that is when women need support most. We are looking into this, we are pushing this and we are looking into providing that, hopefully as part of the GP contract.
Luciana Berger (Liverpool, Wavertree) (LD)
People outside the House will have listened to the Minister’s warm words, yet we know that still far too many people right across our country are having to travel hundreds of miles to access services. Young people having to travel 300 miles to get a bed is unacceptable. Will the Minister tell us whether the investment she outlined will be ring fenced, because it has not been thus far? Will she also be investing specifically in young people’s mental health services?
Ms Dorries
That is a big question because it covers two areas. This Government have invested £2.3 billion in mental health services, a huge amount of which is to go into salaries, to deliver community health services where they are needed: close to patients and to their relatives and families. It is also to provide community health teams and support teams in schools for young people. Clinical commissioning groups are under an obligation to provide those mental health services with the set funding. If the hon. Lady would like to meet to hear more about that, I will be happy to discuss it with her.
Mr Jeremy Hunt (South West Surrey) (Con)
As this is your last Health questions, Mr Speaker, may I thank you for your many years of campaigning for speech and language therapy for children? It has given great hope to many families in a situation similar to your own.
On the issue of early intervention, given that half of all mental health conditions are established before the age of 14, does the Minister, who is passionate about this, agree that mental health provision in schools is essential? Will she update the House on progress towards the 2023 objective of a quarter of schools having a mental health lead?
Ms Dorries
I thank my right hon. Friend for his question and for his work as Secretary of State. He was the longest-serving Secretary of State for Health ever, and he is passionately interested in this subject, too. Yes, we are on track—in fact, we are more than on track—to meet our objective of 25% of schools being covered by a school mental health support team by 2023-24.
The school mental health support teams have been launched in trailblazer areas, and I visited one a few weeks ago at Springwest Academy in Hounslow to see the amazing work the teams are doing with young children. The teams are teaching coping strategies and identifying mental health problems as they arise very early in life, which helps children to deal with those mental health problems now and into adulthood. We are on track and we hope to meet that objective.
Paula Sherriff (Dewsbury) (Lab)
Last week it was reported that a 16-year-old boy in Milton Keynes tragically died by suicide. His referral to mental health services was rejected because he did not meet the threshold as his mental health problems were not deemed severe enough. This is deeply shocking, and it is clear that too many children are going without the support they need. Will the Minister now match Labour’s commitment to invest in children’s mental health services and to ensure that every secondary school has access to a trained mental health professional?
Ms Dorries
Obviously I cannot comment on an individual case, but what I can say is that the NICE guidelines on assessment for suicide were recently sent out to A&E departments to ensure that people who present with mental health problems are treated holistically and looked at in the round to assess whether they are a suicide risk.
We are investing £2.3 billion in mental health services—more than invested by any previous Government—and a huge amount of that is going towards children and young people. I hope cases such as the one highlighted by the hon. Lady will be a thing of the past. We have turned a corner. We are rolling out these mental health teams and, in the last year alone, 3,000 more people are working with young people and young adults. We have the new training scheme and the school mental health support teams. There is more to be done, but I hope such stories will become a thing of the past.[Official Report, 5 November 2019, Vol. 667, c. 8MC.]
Helen Goodman (Bishop Auckland) (Lab)
Andrew Rosindell (Romford) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
Everyone now has easier and more convenient access to GP services, including appointments in the evenings and at weekends. There are also substantial improvement programmes in place related to seven-day hospital services set out in the NHS long-term plan, including hospitals with major A&E departments providing same-day emergency care services 12 hours a day, seven days a week, by the end of 2019-20.
Andrew Rosindell
I thank the Minister for her reply, but I am increasingly concerned that my constituents in Romford often have to wait three weeks or even longer for routine appointments with their GPs. What action are the Government taking to ensure that such long waiting times are reduced and preferably eliminated altogether?
Ms Dorries
I thank my hon. Friend for that question. Just over 40% of all booked appointments take place on the same day with GPs. However, it is important to recognise that many patients will be appropriately booking ahead as part of the ongoing plan for long-term conditions. The new GP contract will see billions of pounds in extra investment for improved access to GPs, expanded services at local practices and longer appointments for patients who need them. NHS England is working with stakeholders and is undertaking a national review of access to general practice services.
Rushanara Ali (Bethnal Green and Bow) (Lab)
With more than 5 million people across England unable to book an appointment with a GP outside working hours, many of our constituents have had to wait two or three weeks to get an appointment. With the loss of 1,600 full-time GPs since 2015 and billions of pounds in cuts since 2010, does the Minister realise that the NHS is certainly not safe with the Conservative party, and that is what the British people think?
Ms Dorries
I simply do not recognise the scenario that the hon. Lady has just articulated. There is access to GP practices throughout England outside of working hours.
Alistair Burt (North East Bedfordshire) (Ind)
Ms Dorries
It is a delight to take a question in my first Health questions from my right hon. Friend and constituency neighbour. If he pops into Shefford pharmacy, I am sure that Jamil will give him a flu vaccine as he walks through the door because Jamil does not require anybody to wait; anyone who wants a vaccine can have one—think pharmacy first. We are also ahead on flu vaccines for pensioners compared with last year. As my right hon. Friend articulated, it is crucial that those in the at-risk groups are vaccinated first to protect themselves this winter. We are targeting patients through the “Help Us, Help You” campaign, which highlights the impact of flu on those who are most at risk, and we are ahead of our targets from last year.
Several hon. Members rose—
Gareth Thomas (Harrow West) (Lab/Co-op)
The three walk-in centres that provide a seven-day-a-week service in my constituency are closed or closing. Why?
Ms Dorries
I did not hear the hon. Gentleman’s question in full, but I would be happy to meet him afterwards to talk about the matter in more detail.
Kelvin Hopkins (Luton North) (Ind)
Caroline Nokes (Romsey and Southampton North) (Ind)
There is still too much reliance on body mass index as an indicator of good health in sufferers of eating disorders. Will the Secretary of State get behind the “Dump the Scales” campaign and meet the indomitable campaigner Hope Virgo, to ensure that GPs realise there is more to eating disorders than just weight?
The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
I thank my right hon. Friend for her question. The National Institute for Health and Care Excellence guidelines state clearly that GPs should not use BMI as the sole indicator for treatment. I have just met the eating disorder charity Beat to discuss how we approach eating disorders. With the £2.3 billion that we have invested in mental health services, we have made a commitment that any young person presenting with an acute eating disorder will be seen within one week, and others within four weeks.
Laura Smith (Crewe and Nantwich) (Lab)
Rachael Maskell (York Central) (Lab/Co-op)
The primary care mental health service in York is not being cut; it is being scrapped. Will the Secretary of State urgently meet me to save this service?
Ms Dorries
I am happy to help and to meet the hon. Lady to talk about that. No primary care mental health services should be cutting given the amount of funding we are putting in, but I am happy to meet and discuss it with her.
Several hon. Members rose—
Health and Social Care
Nadine Dorries Excerpts(5 years, 1 month ago)
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Ms Dorries
Under just-in-time arrangements, drug companies would have a stockpile of a week’s supply, but now all drug companies have stockpiled six weeks’ worth of medications to be used in the UK, and I do not envisage a shortage of any drug that is required.
[Official Report, Sixteenth Delegated Legislation Committee, 7 October 2019, c. 8.]
Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):
An error has been identified in my closing speech.
The correct information should have been:
Ms Dorries
Under just-in-time arrangements, drug companies would have a stockpile of a week’s supply, but now the vast majority of suppliers of prescription-only and pharmacy medicines from the EU have stockpiled six weeks’ worth of medications to be used in the UK, and I do not envisage a shortage of any drug that is required.
Ms Dorries
Companies will be required to operate a pharmacovigilance system from exit day. The master file is in the description of the pharmacovigilance system and the amending SI, which includes statutory contributions associated with a temporary exemption, to ensure supervisory capability of the companies, the QPPV and the MHRA.
[Official Report, Sixteenth Delegated Legislation Committee, 7 October 2019, c. 10.]
Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):
An error has been identified in my closing speech.
The correct information should have been:
Ms Dorries
Companies are required to operate a pharmacovigilance system from exit day. The master file is the description of the pharmacovigilance system and the statutory conditions included in the amending SI should ensure supervisory capability of the companies, QPPV and the MHRA.
Baby Loss Awareness Week
Nadine Dorries Excerpts(5 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
What an important debate this has been, and that is of course thanks to the efforts of my hon. Friend the Member for Eddisbury (Antoinette Sandbach) and the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Colchester (Will Quince), who has been sitting next to me throughout the debate. In fact, I believe that my hon. Friend the Member for Eddisbury still chairs the APPG on baby loss. This is the fourth year that the House has had this debate, and I hope that my hon. Friends continue to push for it to be held every year, forever. It is such an important time not only to focus on the areas that people feel we should be concentrating on, but also to focus on the achievements and to hear stories from so many people.
In the 10 minutes that I have, I would like to respond to some of the points made. I begin with my right hon. Friend the Member for South West Surrey (Mr Hunt), the former Secretary of State, who, in his usual modest way, omitted to mention the incredible contribution he has made in this area. He spoke passionately about changing from a culture of blame to one of learning; he brought that about in the NHS through his own efforts when, while in the Department of Health and Social Care, he introduced the Healthcare Safety Investigation Branch. He instructed it to undertake, I believe, 1,000 maternity investigations a year, including into stillbirths and other mortality issues.
My right hon. Friend asked how we will share lessons learned between trusts and improve patient safety. HSIB has established a process for doing that. The perinatal mortality review annual report will be published on Thursday, as I think he may know. The HSIB annual report will be published in due course. Both reports will begin to share some of the learning from more than 1,500 cases. We are doing more to share information when things go wrong, and as a result of the former Secretary of State’s initiative, when something goes wrong in one trust, we will ensure that it does not go wrong in another. We all hope that will be the outcome of HSIB. We cannot thank him enough, and I am sure we will be mentioning his efforts for many years to come.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke powerfully about her loss. One of the themes of the debate has been mental health and the support that those who have lost a baby, including fathers and others in the family, need at a time of loss. She moved me to tears. She spoke about testing for pre-eclampsia. In April, NHS England announced that it will make the placental growth factor blood test available across the country, in the light of evidence that the test speeds up the diagnosis of pre-eclampsia. I urge her to push for parity in Scotland, so that the same test given to mothers in England is made available to mothers in Scotland. I am sure that other Members will call for that in this place. I know that other Members in this House have suffered loss through pre-eclampsia. It is a dreadful condition. Our objective should be to do all we can to ensure that no mother has to go through that.
Stephen Gethins (North East Fife) (SNP)
The Minister makes a very good point. I pay enormous tribute to my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson), who has done phenomenal work in bringing her experiences to the Chamber. I thank the Minister for her remarks. We may not always see eye to eye, but on this issue, it would be great if her Department and the Scottish Government worked closely together.
Ms Dorries
I have already sent a message to my team asking why the test is not being done in Scotland and what we can do to ensure that it is rolled out across the UK. If I can have those conversations with the devolved Administration, I certainly will, and I will certainly push that from my end and in my Department.
Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)
I share the sentiments of the hon. Member for North East Fife (Stephen Gethins): collaboration is critical. One of my constituents raised with me concerns about the fact that there was no peer-to-peer support provided by the medical profession. She was dealing with her GP, but she relied for support on the charity SiMBA—Simpson’s Memory Box Appeal—a friend having referred her. Maximum co-operation and support are critical. Hopefully, we can share as much information as possible, so that we avoid people feeling that they are alone, or not being given the support that they need. I was shocked to hear what happened to my constituent. I would be keen to ensure co-operation and to promote it as much as I can.
Ms Dorries
I thank the hon. Gentleman for his contribution, but I only have a few minutes left, so I have to move on.
My hon. Friend the Member for Eddisbury asked what we are doing to eliminate the stigma around mental health. As the Minister for Mental Health, I can say that we are doing a huge amount. I do not know whether anybody in the Chamber has managed to see it yet, but a campaign video was released this week called “Every Mind Matters”, which the royals kindly voiced over. It was written by Richard Curtis and features many celebrities, including Davina McCall. It is all about people who everybody knows and recognises talking about their own mental health issues, to break down the stigma. That is just one of the many campaigns that are taking place.
As I said in the debate on women’s mental health last week, when somebody breaks their leg, we put a plaster cast on the leg, and that is fine. When someone has a mental health issue, they do not want to talk about it. I hope that the stigma is reducing and that there is parity and equality between mental health and physical health. Campaigns like “Every Mind Matters” are getting us there.
Antoinette Sandbach
I am grateful to the Minister for giving way. The really good evidence that was disclosed in the debate about the way in which maternal loss of babies can cause PTSD shows that there needs to be concrete mental health support for parents who have gone through this experience.
Ms Dorries
What I will say to my hon. Friend in response is that, in the long-term plan, the NHS commits to
“improve access to and the quality of perinatal mental health care for mothers, their partners and children”.
We have committed in the long-term plan that an additional 24,000 women will have access to specialist perinatal mental health support, including more support for fathers and partners. That is part of the £2.3 billion investment in mental health that this Government recently announced. I will say it again: £2.3 billion. That is over half the annual prisons budget. Of course, some of that money has to be directed towards mothers in this situation.
My hon. Friend the Member for Banbury (Victoria Prentis) made an important point about infant mortality in other countries around the world. The Secretary of State for International Development announced a £600 million reproductive health supplies programme to help end preventable deaths of mothers, newborn babies and children in the developing world by 2030. It will give 20 million women and girls access to family planning, prevent 5 million unintended pregnancies each year up to 2025 and focus on the most vulnerable women, including FGM survivors. We are committed to working with Gavi, the Vaccines Alliance, to vaccinate a further 300 million children in the world’s poorest countries by 2025.
My hon. Friend also talked about making maternal mortality a never event. I am not sure that that will be an achievable objective, but NHS England is supporting the establishment of maternal medicine networks, which ensure that women with acute and chronic medical problems have timely access to special advice and care at all stages of their pregnancy.
The hon. Member for Ellesmere Port and Neston (Justin Madders) spoke about grief. Grief, for me, is the last taboo; it is the one thing that people still do not talk about. People still do not talk about how grief affects them, and I hope that some of the investment we are putting into mental health services and community services will help people to address grief.
My hon. Friend the Member for Brigg and Goole (Andrew Percy) spoke about somebody who works in his office who has raised funds for the Cherished suite, and the right hon. Member for Broxtowe (Anna Soubry) spoke about the serenity suite. Over 50% of hospitals now have such suites, which are so important. I do not want to reiterate what anybody has said, but the fact that babies are born in a part of a hospital that is traditionally filled with joy is incredibly difficult. My hon. Friend the Member for Colchester has told me that it makes such a difference if people have somewhere to go and even to stay overnight with their baby, and where the family can go. Over 50% of hospitals in the UK have these suites, and I am going to ask that these suites are made available in the maternity areas at all the 40 new hospitals that are being built. [Hon. Members: “Hear, hear.”] I will ask; I will certainly push.
I want to continue with the points raised, and please pull me up if I miss anybody out. The hon. Member for Strangford (Jim Shannon) spoke so passionately—thank you. I know he has spoken in every baby loss debate we have had, and he has also spoken in the past about the important role that chaplains play in such situations. I would like to thank him for his incredible contribution. He asked about the pregnancy loss review. It is currently working with key partners to make recommendations to the Government about improving the care and support that women and families receive when experiencing a pre-24 week gestation baby loss. We are hoping the report will be published in due course and not too long from now.
I would like to speak about an area that I have particularly focused on, which is group B strep support. I have spoken about this many times, and I had my own Adjournment debate on it before I was a Minister. When I arrived in the Department, I set five key priorities, and this is No. 1 in the key priority areas because this in itself will prevent infant mortality. Group B strep is a leading cause of bacterial infection in newborn babies—just to put that on the record. I fully support the review that is taking place, and I hope that it has some further information so that we can make progress on this in, I hope, the not-too-distant future.
The hon. Member for Rotherham (Sarah Champion) spoke about hospices. I have Keech Hospice in my own constituency. I think hospices and their role is slightly outside the debate, bearing in mind the level of investment that we are putting into mental health services and counselling services. Somebody mentioned improving access to psychological therapies and the importance of talking therapies. I hope that any mother or family who needs mental health counselling as a result of baby loss will in future be able to access those services. I will write to her about the role of hospices in this particular area.
I appreciate the support from Members on both sides of the House in relation to the maternity safety ambition. I echo your words, Madam Deputy Speaker, about the tone of this House in such important debates. One of the most important things to come out of the debate today is the importance of learning for improvement and what we are beginning to learn through the perinatal mortality review tool and the Healthcare Safety Investigation Branch, which I have mentioned, that was introduced by the former Secretary of State.
I would like to remind Members that the NHS is still—and the NHS in the UK is still—the safest place in the world to have a baby: 0.7% of all births result in a stillbirth or a neonatal death. Having said that, on a day like today, 12 babies in England and 15 across the UK will be stillborn or die soon after birth, and many more families will lose a baby through miscarriage, ectopic pregnancy and other causes. We are, however, making progress: in 2015, the figure was 17 babies a day. Maternity and neonatal safety initiatives are beginning to improve outcomes, with most of the anticipated impacts still to be realised, as safety improvements are embedded in maternity and neonatal services and as we learn more from research and investigations about which babies die and why.
Finally, as we have discussed, the theme of Baby Loss Awareness Week 2019 is psychological support for those bereaved parents who need it. I understand that a working group is being convened to support the development of maternity outreach clinics that will integrate maternity reproductive health and psychological therapy for women experiencing mental health difficulties arising from and directly related to the maternity experience. I will undertake to ask this working group if it could consider extending the maternity experience to those who have lost a child in pregnancy, during labour and childbirth in the neonatal period.
I would like to finish by thanking all the midwives, doctors and healthcare support workers who do such a fantastic job in delivering more than 600,000 babies successfully every year and in helping the parents who, sadly, do not experience the happiness of a healthy baby.
Madam Deputy Speaker (Dame Eleanor Laing)
Thank you. What an excellent, calm and constructive debate.
Question put and agreed to.
Resolved,
That this House has considered baby loss awareness week.
Health and Social Care
Nadine Dorries Excerpts(5 years, 1 month ago)
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Ms Dorries
On the maternal six-week check, we hope to ensure that that happens in all our GP contracts going forward.
[Official Report, 3 October 2019, Vol. 664, c. 1441.]
Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):
An error have been identified in my winding-up speech during the debate on Women’s Mental Health.
The correct information should have been:
Ms Dorries
On the maternal six-week check, we will look at that happening in all our GP contracts going forward.
Ms Dorries
The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to end restraint. We know that it continues to be a routine occurrence on many wards, affecting women and girls disproportionately. That has to end.
[Official Report, 3 October 2019, Vol. 664, c. 1443.]
Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries):
An error has been identified in my winding-up speech during the debate on Women’s Mental Health.
The correct information should have been:
Ms Dorries
The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to minimise the use of restraint. We know that it continues to be a routine occurrence on many wards, with prone restraint affecting women and girls disproportionately. That has to end.
Draft Human Medicines and Medical Devices (Amendment etc.) (EU Exit) Regulations 2019
Nadine Dorries Excerpts(5 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
I beg to move,
That the Committee has considered the draft Human Medicines and Medical Devices (Amendment etc.) (EU Exit) Regulations 2019.
It is a pleasure to serve under your chairmanship, Mr Bone. Hon. Members will be aware that in March this year the House considered and approved the statutory instruments that aim to ensure that our national regulatory system for medicines and medical devices continues to function appropriately in the event that the UK leaves the EU without a deal. Before us today is a draft statutory instrument that makes additional changes to that legislation in areas that my Department has identified would benefit from further clarification. This is being done in response to comments from stakeholders, including the industry and the life sciences sector, and from internal review.
I reiterate that the Government’s position remains that the UK would prefer to leave with a deal, and we continue to work towards that. However, the Government are also committed to preparing for an outcome in which a deal is not reached and we have to leave the EU without a deal.
I reassure all hon. Members that, as the former Minister said in March, the Government are fully committed to a system of medicines and medical devices regulation that intelligently balances patient access to new, innovative and world-leading products with protecting UK patients from harm. The Medicines and Healthcare Products Regulatory Agency, as part of these measures, will have in place a suite of licensing routes for medicines and vigilance systems for medicines and devices. The UK Government also place enormous value on the contribution to public health of research charities, the industry and the life sciences sector as a whole. The MHRA will therefore continue to support innovation in the life sciences through its innovation office and scientific advice. We are committed to offering a competitive regulatory environment to ensure that the UK has access to the safest and most effective medicines and medical devices.
The fundamentals of how medicines and devices are regulated will remain the same, in terms of the UK’s regulatory system. Where possible, we have sought to maintain existing arrangements rather than to create any new ones. However, there are a few areas where it has been necessary to add a new requirement, and we have consulted the industry and other stakeholders on our proposals in those areas. These regulations will ensure continuity in the area of medicines and medical devices in a no-deal EU exit. This legislation does not prevent future changes that we may wish to make to ensure that the UK maintains an appropriate regulatory environment and remains one of the best places in the world for science and innovation.
The Department’s priorities have been to ensure that timely availability of safe and effective medicines and medical devices continues, while minimising disruption to patients and businesses, and ensuring that the UK regulator is able to continue to protect public health. That continues to be the case with this SI.
I will now give hon. Members some more detail about the arrangements set out in these regulations. I must emphasise that the proposed changes are technical in nature and do not represent any change to underlying policy. The instrument corrects minor drafting errors and seeks only to ensure that the original policy intention is delivered. Specifically, for medicines it includes the following. First, it clarifies that the requirements for a responsible person for import and wholesaler’s licences apply to hospitals importing human medicines for their own use directly from a country on an approved list.
Secondly, it clarifies that UK generic applications can rely on data supplied in relation to medicinal products whose EU marketing authorisations were cancelled pre-exit on grounds other than safety, quality and efficacy.
Thirdly, it introduces additional detail in relation to the process by which companies may make representations to the Commission on Human Medicines about decisions on rare disease medicines and paediatric matters.
Fourthly, it includes the provision of a temporary exemption, subject to specific conditions, from the obligation to maintain a UK pharmacovigilance system master file for companies whose UK authorisations are included in an EU file. That also includes the condition that information required by the licensing authority is provided by the marketing authorisation holders on request.
Fifthly, it includes the clarification that the temporary exemption as to the geographical location of an appropriately qualified person for pharmacovigilance applies to all the marketing authorisations and herbal registrations a company holds, whether granted before, on or after exit day. That is provided that they are covered by a single pharmacovigilance system in respect of which there is the same qualified person.
Finally, it includes the addition of the Republic of Korea to the approved list of countries with equivalent regulatory standards for the manufacturing of active substances on exit day, which reflects updates to the EU list since the no-deal SI was made.
For medical devices, some changes result from the amendments made by the EU to the underlying EU medical devices regulations via the recently published corrigendum since the no-deal SI was made. The changes are minor or technical corrections. Two further changes are inserted to ensure that products used mainly for cosmetic purposes are required to comply with common specifications and to require the information registered with the MHRA about medical devices to be updated by the manufacturer.
In conclusion, in the event of a no-deal exit, the regulations will minimise any impact on patients and business to ensure the timely availability of safe and effective medicines in the UK market by putting in place changes that will ensure that the UK’s legislation in these areas continues to function effectively from day one.
Ms Dorries
I will not comment on the hon. Lady’s opening comments about a no-deal exit, because obviously we are where we are, we all stood on a manifesto to honour the result of the referendum, and it is not my position to comment on a no-deal exit.
I will answer the hon. Lady’s more specific points. It is important to make the point that at any one time in the UK there is a shortage of over a hundred medicines, and that has absolutely nothing to do with Brexit, as I am sure she knows. It can be to do with fires in factories, or a downturn in supply from abroad. At any one time there are shortages, and any shortages today have nothing to do with Brexit.
Julie Cooper
I absolutely agree with what the Minister has just said. I have personal experience of pharmaceutical provision in the UK and I know that what she has just said is true. However, does she not agree that exiting the EU with no deal will exacerbate existing problems?
Ms Dorries
The hon. Lady will not be surprised to know that I do not agree, because I believe—I cannot guarantee, but I believe—that all efforts are being made and all arrangements are in place to ensure a supply of drugs into the UK. Under just-in-time arrangements, drug companies would have a stockpile of a week’s supply, but now all drug companies have stockpiled six weeks’ worth of medications to be used in the UK, and I do not envisage a shortage of any drug that is required.[Official Report, 14 October 2019, Vol. 666, c. 1MC.] Obviously, I cannot guarantee that—that cannot be done—but every effort has been made by every Department and every official and in every negotiation with drug suppliers and pharmaceutical companies to ensure that they have a six-week supply ready for a no-deal Brexit. We do not see any problem with that.
The hon. Lady referred to drugs with short shelf lives, which cannot be stockpiled. In that instance, arrangements have been made for those drugs to be air freighted into the UK. She mentioned isotopes in particular. They cannot be stockpiled, but they will be airlifted into the UK, so we will see absolutely no shortage of isotopes either. I am sure that we can provide further information on that, but I hope that, now that hon. Members are aware that drugs that have no shelf life will be airlifted, we will not hear those stories. What worries me, and what worries many people, is the public perception when they hear stories that there will be no isotopes because they cannot be stockpiled. We must take our responsibilities very seriously here.
Julie Cooper
I can assure the Minister that I take my responsibilities in this very seriously. I know that many hon. Members here do too—including her, I am sure. But this is not just a case of political to-ing and fro-ing, trying to create a sense of panic in the community about this. When the medical professions are leading the voices of concern, surely the Government should be listening to their worries.
Ms Dorries
I assure the hon. Lady that we do, and I hope that they will see today’s debate and be reassured that there will be no shortage of drugs with short shelf lives, because they can be airlifted in.
The hon. Lady also asked how we can be confident that there are no more mistakes. I think she is referring to the grammatical errors and various technical errors that occurred in the previous SI, which was 700 pages long and very technical in its content. Those issues were not identified at the time by any party or any individual, but they have now been identified. The amendments that this new SI makes to the previous SI are minimal and include updates to the underlying EU regulations that have been brought forward since the original SI was finalised.
This particular SI has also undergone legal checking and been scrutinised by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee, and we are confident that it will ensure that these regulations operate effectively after exit day. If the hon. Lady does not feel that she has had enough detail, we will provide anything in writing as a back-up.
The hon. Lady asked what paediatric investigation plans mean. This SI does not introduce paediatric investigation plans; they are already required by EU legislation. The previous no-deal SI simply transferred functions relating to those plans from the EU to the MHRA. She also asked why there was no impact assessment. There are no new policies in this SI, so there is no need for a further impact assessment. The MHRA ran a four-week public consultation and published an impact assessment on the previous SI. This SI ensures that the policies implemented are in line with the consultation and the responses to it.
On the protection of patients, the hon. Lady asked about an interim period relating to a transitional period for a pharmacovigilance system. The new proposed transitional period is for the pharmacovigilance system master file, which will be held in the UK. Companies will be required to operate a pharmacovigilance system from exit day. The master file is in the description of the pharmacovigilance system and the amending SI, which includes statutory contributions associated with a temporary exemption, to ensure supervisory capability of the companies, the QPPV and the MHRA.[Official Report, 14 October 2019, Vol. 666, c. 1MC.] I think that she also mentioned the safety aspects. Each pharmaceutical company will be required to have safety staff in the UK in line with this.
The hon. Lady asked whether new and innovative medicines would be delayed in the UK under a no-deal scenario. The MHRA intends to provide free scientific advice for UK-based small and medium-sized enterprises and has introduced a new targeted assessment procedure to authorise medicines as soon as possible following an EMA-positive opinion. In addition, it will often accelerate an assessment route to enable licensing more quickly than in the EU. The MHRA would monitor application volumes in a no-deal scenario.
I thank the hon. Lady for her valuable contribution to the debate. As promised, we will get back to her with further information in writing if she requires it. I am confident, as was the case in March, that we have a shared intention to protect and improve the safety of patients using medicines and medical devices, while enabling their access to the most innovative treatments.
Our regulator, the Medicines and Healthcare Products Regulatory Agency, has more than 30 years’ experience as a leading regulator in the EU. That expertise and experience is globally recognised and respected, and we want to ensure that continues, to the benefit of all UK patients. It is with that at the forefront of our minds that the UK’s plans for the regulation of medicines and medical devices in a no-deal scenario have been developed.
Question put and agreed to.
Women’s Mental Health
Nadine Dorries Excerpts(5 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
I hope everyone will concur that this debate has followed on in tone from yesterday’s debate on the Domestic Abuse Bill. I thank everybody for their contributions. I thank the hon. Member for Bath (Wera Hobhouse) for opening the debate. I also thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer), who I understand originally secured the debate—when he took up his ministerial position, the hon. Member for Bath took the debate forward on his behalf, for which I thank her.
I give many thanks to my predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who did a hugely commendable job when she held this position. I am determined to continue the work that she began—not least because I am sure she will be breathing over my right shoulder in every debate that I take part in. I wish to pick up on one of her comments, which fitted the tone of debate. She said that we should all share in this place the results of our own personal experiences. I was not going to mention why women’s mental health is so important to me, but that comment has sat on my shoulders since she made it—as have, indeed, the other brave contributions.
Women’s mental health, particularly perinatal depression, is incredibly important to me because a very close member of my family had perinatal depression and took her own life—and not only her own life but that of her baby and her two existing children. It was an act that has since reverberated through my family, and for many other people. Perinatal depression is incredibly important to me, as is this role, and that is why I take so seriously all aspects of my role but particularly women’s mental health.
Women have broken down barriers, not only in mental health but in this place. I remember well the time when a previous Madam Deputy Speaker was pregnant. She spent most of her time in the ladies’ room at the back because the fact that she was sat in the Chamber and was pregnant at the time was not quite appreciated. Times have changed and sharing our experiences has now become commonplace. I think that has helped to break down the barriers in here so that we can discuss issues that are so important to so many people.
Andrew Griffiths (Burton) (Con)
I thank the Minister for sharing her personal story with us. The more we hear from Members from all parties who have themselves suffered from poor mental health or whose families have felt the footprints of poor mental health, the more we will help to break down the stigma and the more we will show to people who are listening to this debate or watching on TV that it can happen to anybody. There is nothing to feel embarrassed about and there is nothing to be ashamed of. The most important thing we can all do is talk about our mental health.
Ms Dorries
My hon. Friend is absolutely right: it is about breaking down the stigma in mental health. When somebody breaks their leg, they wear a plaster cast and we can see that they have broken their leg. We cannot always see when someone is suffering from a mental health issue, so it needs to be destigmatised. It also needs to be given the same consideration as physical illness, and I think it is.
Obviously, my speech has now been dumped, because so many points were raised in the debate and I feel that I have to answer them. I shall start with the hon. Member for Bath, who raised so many points when introducing the debate. I want to answer some of her questions. One of her first points was about rape crisis centres; this year, we will spend £35 million and fund 47 sexual assault referral centres, to ensure that when sexual violence occurs, there is the best possible response for victims. The centres are available to all victims—male and female, adults, children, and current and non-current victims of rape and abuse.
I want to mention the approach the Government have taken to mental health. I took up this post just as we announced £2.3 billion of expenditure on mental health. Let me put that into perspective: my hon. Friend the Member for Cheltenham (Alex Chalk) informed me that that is more than half the entire yearly prisons budget; that demonstrates how much money we are investing in mental health. The money is going into many areas, but in almost all areas it will have an impact on women and young girls— and this debate is all about women’s mental health. It is important that women are at the centre of all mental health policy. They should be not just be siloed off into their own particular areas; they should be at the centre of everything.
Mr Kevan Jones
I understand what the Minister says about the increase in budgets, but does she not also realise that cuts in other areas are actually adding to the problems? Therefore, it does not matter how much money we pour into mental health services. Public health funding, for example, which is devolved to local authorities such as Durham, has had a 40% cut, which means that existing services, such as those for substance abuse, have had to be cut. Putting money in one way and taking it out in another does not solve the problem.
Ms Dorries
The NHS budget is not bottomless, but the mental health budget is growing faster than the overall health budget, and the budget for children and young people is growing even faster than that. One Member—I think it was the hon. Member for Lewisham West and Penge (Ellie Reeves)—said that more people are presenting with mental health issues now than ever before. In fact, GPs agree with that, and say that a lot more people are presenting with those issues at their surgeries. That is due to many, many reasons. One Member raised the issues of the postings on Facebook and Instagram, of body image and of dieting. There are many reasons why people are suffering from mental health issues, and it is not just to do with service cuts, which are being addressed.
I need to race on with my speech because I have just three minutes left. On the maternal six-week check, we hope to ensure that that happens in all our GP contracts going forward.[Official Report, 7 October 2019, Vol. 664, c. 11MC.] The hon. Member for Bath mentioned the Istanbul convention. The Government signed the Istanbul convention in 2012 to reaffirm our strong commitment to tackling violence against women and girls. She also talked about eating disorders—I know that she has brought forward other debates on this issue. She also mentioned body mass index. We want all GPs to adhere to the NICE guidelines, which means that they must take a holistic approach to young women who are presenting with potential eating disorders. I am talking about taking a look at dental records, considering whether those women are still living a full life and still working, whether they are seen to be eating or whether they are absenting themselves after a meal. We need to look at everything in the round. Nobody should be referred for having an eating disorder based on their BMI alone. That is in the guidelines. We are raising awareness of that, and introducing more training for GPs, so that they are aware of this, too. The hon. Lady may be aware that I wrote an article on this subject recently, emphasising that point.
Perinatal mental health, as we discussed, is also important. According to one study published in 2014, a shocking 10% to 20% of women develop a mental health illness during pregnancy, or within the first year of having a baby. From April 2019, new and expectant mums have been able to access specialist perinatal mental health community services in every part of the country.
The NHS long-term plan, which I referred to earlier, commits to ensuring that an additional 24,000 women will have access to specialist perinatal mental healthcare, with more support for fathers and partners. I am pleased to see that NHS England has expanded the capacity of in-patient mother and baby units, which are in-patient services that support women with serious mental health issues, keeping them together with their babies, which is so important.
My hon. Friend the Member for Southend West (Sir David Amess) talked about female offenders. I know that women in prison often have a disproportionately high level of mental health problems, and there are also worrying levels of self-harm. We have recently published standards for healthcare for women in prison and are looking at improving care for pregnant women in prison.
The hon. Member for Lewisham West and Penge talked about health visitors. Earlier this year the Prime Minister announced our commitment to modernise the healthy child programme to reflect the latest evidence on how health visitors and other professionals can support perinatal mental health.
My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about the closure of children’s centres. We are investing £84 million over the next five years to support up to 20 local authorities that are seeing high demand for children’s social care. This will help to support the most vulnerable families, and I am sure that that is welcomed by everyone. It is up to local councils to decide how to organise and pay for services in their areas, as they are best placed to understand local needs.
The right hon. Member for North Durham (Mr Jones) talked about social media and about his constituent trying to get Facebook to take down an advert. I actually congratulated Facebook and Instagram recently on removing all the diet advertisements for miracle cures and diet teas that simply do not work. That is a step in the right direction. I also thank all the women in my constituency who have emailed me on that the issue and others.
Ms Dorries
I do not have any time; I have only 30 seconds left.
The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about poverty. Many of us in this place understand the impact of poverty and have experienced poverty ourselves, and we know that it can cause anxiety not only for women, but for young girls. We absolutely understand those issues.
Let me say to the shadow Minister that our £2 million programme Standing Together Against Domestic Violence looks at how the whole health system can better respond to domestic abuse. Like her, I was delighted that the Domestic Abuse Bill passed its Second Reading yesterday. On carers and increased access, the carers action plan published in 2018 sets out a range of ways that we will improve support for carers. We published a progress review in July this year to ensure that we focus on delivering the plan.
The shadow Minister also spoke about the use of restraint, which is abhorrent. The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to end restraint. We know that it continues to be a routine occurrence on many wards, affecting women and girls disproportionately. That has to end.[Official Report, 7 October 2019, Vol. 664, c. 12MC.]
I will conclude by stating again that we are putting £2.3 billion into mental health, and that will benefit women and young girls. Never before have any Government ever considered mental health in such a way—with regard to policy, and finance to drive that policy and back it up. I thank the hon. Member for Bath for raising this very important issue. We are making progress, and I am determined that we will make more. I recognise that there is more to do and we will certainly be working on that.
Artificial Intelligence in Healthcare
Nadine Dorries Excerpts(5 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
It is a great pleasure to serve under your chairmanship, Mr Paisley. The debate has been really interesting, particularly in the light of the number of Members who stood up and admitted that, although they could not send emails, only recently learned how to text and do not use contactless payment cards, they were very much in support of the potential of AI technology and what it can offer patients, healthcare settings and the public at large.
AI is exciting and innovative. I have been in my Department only a few days and I have learned some more from this debate. I hope to have some answers for hon. Members, every one of whom gave an example of the exciting breakthroughs and areas of application of AI, as well as of what it can deliver for patients. That is incredibly exciting.
I thank my hon. Friend the Member for Crawley (Henry Smith) for securing this debate. He made the point about misinformation and fake news. We need more of these debates because Westminster Hall, and this place as a whole, is a good forum to knock down those myths, get rid of fake news and stop fearmongering about the use of AI, because journalists who are interested in AI will follow these debates and quote what hon. Members say. We should have more debates on this subject in future.
Artificial intelligence has the potential to make a massive difference to health and care. There are significant opportunities to save money, improve care and save lives. AI technology could help personalise NHS screening and treatments for cancer, eye diseases and a range of other conditions, as well as free up staff time.
Almost all health and care services can benefit from AI in some way, but realising its potential for our health and care system depends on the involvement of patients. We are committed to working with patients to ensure that they understand and are involved in the decision making about how we use AI to deliver the impact that we both want and need.
I will give a few examples of how AI is working. Some patients have already benefited from it, as hon. Members have highlighted. John Radcliffe Hospital in Oxford has developed a system that uses AI to improve detection of heart disease and lung cancer, as the shadow Minister mentioned. Currently, 20% of heart scans result in a false positive diagnosis, and the subsequent 12,000 unnecessary operations cost the NHS about £600 million a year. The potential financial savings are huge.
Another fantastic example of the use of AI is that of Moorfields Eye Hospital’s implementation of the DeepMind AI algorithm for retina scans. The AI can correctly recommend patient treatment referrals, to the same or better standard as world-leading doctors, for more than 50 sight-threatening eye diseases. Tens of thousands of scans were taken of people with both healthy and diseased retinas, and DeepMind developed software that could detect—long before a doctor could—sight-threatening diseases and the patterns that lead to them. That is just one example.
The use of AI goes further than just diagnostics. NHS 111 online, once fully implemented, will automatically triage patients by using AI technology. The system sends patients to the most appropriate care setting and reduces unnecessary A&E visits, meaning that patients can access the care that they need faster.
We must make best use of the available resources within the NHS to harness the full potential of AI, which relies heavily on enormous amounts of data to learn and become effective at its task. That data must be shared safely, however. Health data that is shared fairly, ethically and transparently has the potential to improve outcomes for patients, improve the efficiency and efficacy of the NHS, and underpin the next wave of innovative research taking place in the UK.
To help the NHS and researchers share health data in a safe, secure and lawful way, the Government have committed to developing a policy framework that sets out our expectations for how the NHS should engage with researchers and innovators when entering data-sharing partnerships. That builds on the work of the code of conduct for data-driven health and care technology. We are committed to involving patients and the public in the development of that policy. That is key and comes back to the point made by the hon. Member for Cambridge (Daniel Zeichner). Patients must be at the heart of and engaged in projects, understanding how their data will be used in future and reassured of its safety.
To support the NHS in embedding the framework in practice, we will also set up a national centre of expertise. The centre will sit in NHSX and provide hands-on commercial and legal expertise to NHS organisations to support them in reaching fair, ethical and transparent agreements for data. Although AI has been the subject of much speculative reporting, on both benefits and risks, we know that it will bring big changes to the way in which care is developed and experienced.
While we promote the latest data-driven scientific advances in healthcare, we must always ensure that patient data is respected and properly protected. Data is vital to the delivery of safe and high-quality care, but we need to ensure that an understandable and trusted system is in place, which patients can be confident will protect their data. The Government are clear that patient data will only ever be used and/or shared when anonymised, or with the consent of the individual, unless for direct patient care. That is an important point and one that almost everyone made.
We have therefore put in place several safeguards, including legislation such as the Data Protection Act 2018, enacting GDPR; data and cyber-security standards applicable across the health and care system; and legislation that is under way to put the National Data Guardian on a statutory footing to provide an independent and authoritative voice on how data is used across the health and care system. We have also launched the national data opt-out, which gives individuals choice of how their data is used beyond their individual care. That gives patients choice, which is important.
In some instances, it will be appropriate for patient data to be shared for secondary purposes, such as when consent has been given on behalf of the patient, or there is an overwhelming public interest in sharing. The National Data Guardian is supporting work with NHSX to clarify and update guidance on the lawful use of patient data to support the understanding of the public, clinicians and industry. We do not want to hinder the progression of innovations, but all patient data should be handled with the respect and care that the public rightly expect.
We are also very aware of the ethical issues that can be raised by artificial intelligence at a personal, group and system level. Bias is a current common issue with the use of AI, and we must curtail any bias within algorithms by ensuring that the data feeding them reflects our diverse population and range of health economies. Initiatives such as DeepMind’s ethics and society research group and the Partnership on AI, which counts IBM, Microsoft, Facebook and Amazon among its members, show that industry is alive to the issues. We are already taking steps to ensure the safe development, deployment and use of AI, and the published code of conduct for data-driven health and care technology that I mentioned earlier encourages technology companies to meet a gold-standard set of principles to protect patient data to the highest standards.
NHSX announced that it would set up an “AI lab” to bring together the industry’s best academics, specialists and technology companies to build groundbreaking diagnostic tools and treatments in line with the NHS’s priorities. NHSX is delivering the Prime Minister’s grand challenge mission to use data, artificial intelligence and innovation to transform the prevention, early diagnosis and treatment of chronic diseases by 2030.
The NHS AI lab will harness the power of data science and AI to continue the UK’s great tradition of using evidence-based decisions in health, public health and social care, and to position the NHS as a world leader in artificial intelligence and machine learning. It will collaborate widely to identify impactful ways to improve the NHS through more sophisticated use of its data. Once identified, the lab will develop, test and deploy early-stage software solutions to be handed over to the NHS to implement at scale.
The operations of the AI lab will align to the core values of the NHS. Most relevant to this debate, the AI lab will protect patient privacy—to go back to the substantive concern expressed by the hon. Member for Cambridge in his speech. The AI lab will sit within the NHS and will protect patient data. It will also guarantee that the value of the healthcare data is retained by the UK public.
As well as ensuring that the technology meets the highest standards and sufficiently stringent regulation, we must ensure that the public are aware of that technology. The public must understand the principles well enough to be confident in a particular technology’s capabilities, irrespective of the statistical evidence supporting it. For the NHS to maintain the confidence that the UK public place in its brand, it must ensure that the apps and data-driven technologies that it recommends are examples of the best practice, not simply in transparency but in what they do and where the personal data goes.
There is now an opportunity for the UK to do that well, making the UK’s standards for MedTech an international benchmark, strengthening the position of digital health in the UK and enabling it to make great leaps forward. As I mentioned, the National Data Guardian and NHSX will work together to produce clarifications on the circumstances in which it is appropriate to share data. We recognise the findings of the “Putting patients at the heart of Artificial Intelligence” report produced by the all-party parliamentary group on heart and circulatory diseases and its calls for greater public engagement to avoid a souring of opinion on AI. We will continue to engage patients in the design and development of AI, where appropriate, and to raise the profile of the effectiveness and efficacy of using AI to provide health and care.
I will now go on to the points made by Members and their requests for reassurance. My hon. Friend the Member for Crawley asked how an NHS organisation investing in the new technologies would be rewarded. We are investigating how best to do that by engaging with commissioners, clinicians, business and academics. We will announce more detail in due course.
The hon. Member for Cambridge asked for an assurance that the additional NHS funding that has been announced will go ahead. Yes, the additional funding will go ahead, but we are still investigating how best to distribute it. My assurance to him is that, yes, the funding will be distributed. He himself highlighted the complexity of ensuring the fair distribution of such funding.
My hon. Friend the Member for North East Derbyshire (Lee Rowley) mentioned mitigating the risks. I hope that I covered that in my speech. A huge amount is going into mitigating such risks. For example, the Information Commissioner provides anonymisation guidance. I also refer to the points I have already made about NHSX.
The Scottish National party spokesman, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about mental health and patients. This morning, I heard about a great example of AI helping a patient suffering with dementia. It is being used to track normal movement and behaviours. When something different or unusual happens in the home to cause concern, an alert is sent out to a first carer who can be on the scene immediately. That is another great use.
The hon. Lady also asked what we were doing about 5G. I will not try to wing this one, but will simply repeat the answer that my officials gave me word for word: we are working closely with the Department for Digital, Culture, Media and Sport, which is leading test beds—is that right?—for 5G in Liverpool and Birmingham, showing how it can improve access to services and exchange of information between patients and clinicians.
The hon. Lady also asked about international collaboration. NHSX will engage with the World Health Organisation through the Global Digital Health Partnership, and the Medicines and Healthcare Products Regulatory Agency has a strong tradition of international engagement with both the US’s Food and Drug Administration and the European Union, which is key to solving difficult regulatory questions.
In conclusion, I reiterate that AI’s potential to transform the way in which we deliver health and care in the UK is huge. Advancements in diagnosis, treatments and prevention facilitated by AI will provide frontline NHS staff with more time to spend providing care to those who need it most. Through our involvement in the Prime Minister’s grand challenge, the AI lab and our work with the National Data Guardian, we will raise the profile of AI as a health and care project, and ensure that the public are fully aware of both its benefits and the expectations they should place on the NHS.
In the last few seconds, would my hon. Friend the Member for Crawley like to wind up?
Hernia Mesh in Men
Nadine Dorries Excerpts(5 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
It is a pleasure to serve under your chairmanship, Mr Hanson. I was alarmed when you walked in, because I think you have held more ministerial posts than anyone else in the House of Commons—or you are pretty close to holding the record, anyway. So to have you in the Chair, judging me as a Minister, is quite daunting.
I thank the hon. Member for Strangford (Jim Shannon) for bringing up this important debate. You always bring debates to the Chamber that you are heartfelt and passionate about. That is so important. It is a delight to be opposite the hon. Member for Washington and Sunderland West (Mrs Hodgson). We have both been in this place for 15 years, and I know that you also bring the same passion and commitment. You always speak from your heart. We might be a bit similar in that way.
Ms Dorries
Of course, Mr Hanson. I am amazed that after 10 years in the Chair I make these mistakes—it is because I am nervous. I am delighted to serve opposite the hon. Lady; it will be great.
This is a serious subject. It is incredibly important to hear the voices of patients who have suffered as a result of inguinal hernia mesh repair operations, because without allowing those patients to be heard, we cannot move forward to find solutions to deal with this issue. I will go off-piste from my speech, because there has been some conflation during the debate of vaginal mesh repair for the purpose of urinary incontinence and inguinal mesh repair for an inguinal hernia. The two operations are entirely different and have completely different outcomes. Vaginal mesh repair is for urinary incontinence. Inguinal mesh repair is for hernia, and without repair, there is a possibility of death. That is because of the pattern of development of an inguinal hernia. It is due to a break in the muscle wall. The hernia is a part of the bowel that comes through the muscle wall, and it can quickly strangulate and develop into peritonitis. The result of that can be death.
Andrew Griffiths (Burton) (Con)
I join the debate late on, but perhaps I can be the example the Minister is looking for. I had a double hernia just a few months ago that was treated at Queen’s Hospital in my constituency, where I received fantastic care. Mesh was used to repair a double hernia, which I got as a result of doing too much exercise—I am not as fit or strong as I thought I was. I was nervous about having mesh because I had heard all the rumours about how damaging it could be, so I questioned the consultant and surgeon. For me, it was brilliant: it meant keyhole surgery and a quicker recovery. I say to all those men out there who might be going in for a hernia operation: do not dismiss mesh, because it makes the operation simpler and the recovery time quicker. I recommend it.
Ms Dorries
I thank my hon. Friend for his absolute honesty and openness in bringing forward his own case.
The bowel can come through the opening in the muscle wall, strangulate and develop into peritonitis, with dire consequences. The fact is that the alternative method of repair—just to stitch the muscle wall—is nowhere near as effective, and the same dangers can present. There can be a rupture, and the hernia will present again with the same complications.
Mrs Hodgson
The Minister, with her medical knowledge, can give the details on hernia repairs in men that otherwise would have been missing from the debate. The hon. Member for Burton (Andrew Griffiths) speaks from his experience. Although I do not want to be a harbinger of doom, for him it is very early days; often the pain that comes in 10% to 15% of cases appears a few years later, as the hon. Member for Strangford said in his speech. The Minister rightly points out that it is a good operation for what is a life-threatening condition in men, as opposed to stress incontinence in women, but still in 10% to 15% of cases we are talking about real pain. I would like her to elaborate on what we should do about that.
Ms Dorries
The hon. Lady is absolutely right. No one should suffer with chronic pain. There is a difference between acute and chronic pain, with acute pain happening immediately post operation and the chronic pain continuing afterwards. In inguinal mesh repair operations, the chronic pain is due to the mesh—like a small piece of net curtain—rubbing up against nerve endings and causing inflammation. For many men, the pain is quickly cured by an injection of local anaesthetic such as lignocaine with a steroid, which reduces the inflammation and takes away the pain completely. For many men who present back in out-patients, their pain is quickly sorted.
I do not want it to sound as though I am trivialising in any way the problems of those who continue to suffer pain. I believe that the Cumberlege report covers mesh as a wider issue, as well as issues related to the use of mesh, so we may gather more information from the report that will inform the debate on inguinal hernia mesh repair.
There are, however, other options. The best practice is shared decision making between the patient and the clinician, with the clinician fully explaining the operation to the patient, what is involved and what the options are. One option for patients who present with a hernia is for the clinician to reduce it in the clinic back in through the muscle wall. At that point, the patient may know how to handle it and manage it by not over-exercising and being careful when they cough. The patient will be registered as having had a hernia reduced and, if they want it operated on, they just ring up and go straight on to the operating list. That is a good option for many men if they think they can carefully and responsibly manage the hernia and come back to hospital only if it gets worse, if it pops again or if they need immediate attention. Whatever happens, they will be registered as having had an inguinal hernia and seen a clinician and therefore in need of treatment should it reoccur.
We are encouraging clinicians to have that conversation with patients. I do not know whether the clinicians treating my hon. Friend the Member for Burton (Andrew Griffiths) did, but clinicians should do so that patients can decide whether they want to go ahead with an operation.
Andrew Griffiths
I had exactly that conversation: it was my choice whether I had an operation and how I managed it. Also, it was just four months between seeing my GP and having the keyhole surgery at my local hospital, which took an afternoon. The service at the hospital was brilliant; I cannot praise it enough.
Ms Dorries
I am delighted to hear that.
I am pleased to say that shared decision making is set out in the NHS long-term plan and I hope we will see more of it in other areas. As the hon. Member for Strangford mentioned, it has the full backing of the Royal College of Surgeons and the Royal College of Anaesthetists. I know from my own experiences in the health service that the role of patient voices is critical at every stage along the treatment pathway. Indeed, as we have said, the Government have asked Baroness Cumberlege to lead a review on the theme of patients’ voices. I will say more about that later.
All of us, including Ministers, regulators and clinicians, must listen to patients, such as the constituent mentioned by the hon. Member for Strangford who has had an ongoing problem, when they raise concerns. Only by listening to those patients’ voices and understanding the issues they have after hernia repair can we learn and develop what we need to do to ensure that it does not happen to people in the future. We must strike a fine balance as we steer through innovation, emerging science, clinical advice and the voices of a multitude of patients.
Hernias are relatively common. One in five men will get an inguinal hernia in their lifetime and it is worthwhile briefly outlining why men are mostly affected. Inguinal hernias are a type of groin hernia, which are the most common type of hernia. Some 98% of them are found in men, as the male anatomy is particularly vulnerable in this region. The main reason to operate on a hernia is to reduce the risk of bowel obstruction or necrosis, which is tissue death. Both of these conditions require major emergency surgery, where there is a risk of death.
Hernia surgery is therefore often a necessity. I have been advised by clinicians that when an individual’s condition indicates surgery, mesh repair is the standard operation for adults with inguinal hernias. It is safer than non-mesh repair in the first instance and is less likely to lead to pain post operation. It is also less likely to lead to hernia recurrence. To address the point made by the hon. Member for Strangford, I hope he understands not only that this treatment is the most effective but that the alternative is more likely to result in complications. Mesh is therefore used in approximately 97% of all surgical inguinal hernia repairs in England.
All the expert scientific advice that Ministers have received does not support a ban. It is important to emphasise that internationally no other country has banned the use of mesh to treat hernias. According to the National Institute for Health and Care Excellence, approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. These mesh repairs are performed by either open surgery or laparoscopic surgery, as my hon. Friend the Member for Burton described.
NICE has developed guidance which recommends laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. The guidance states that it should only be performed by appropriately trained surgeons who regularly carry out the procedure. This evidence was reviewed by NICE in February 2016 and the recommendations have remained in place since then. The Medicines and Healthcare Products Regulatory Agency and others will continue to review the situation as further evidence and analysis emerges, and will take any appropriate action on that basis. That is why this debate and the recounting of the experiences of constituents is important. They have ensured and will continue to ensure the safety of patients who need treatment.
Unfortunately, no type of surgery is without risk, both during and post surgery. The right balance between risks and benefits for individual patients must be achieved, which places patient autonomy and consent at its heart. I stress that I am deeply concerned to hear about instances where these conversations may not have happened, or have not been conducted in a manner that sufficiently informs the patient. Every patient should expect to receive safe and effective care, and to have an opportunity to raise concerns and feel confident that they will be listened to.
I will talk about the pain and suffering experienced by some men after mesh surgery. The vast majority of patients who undergo surgery using mesh to treat hernias go on to live normal, independent lives. While we do not know the exact number of complications, we believe it is low. However, I understand that those who experience the most adverse outcomes are those who suffer chronic pain or long-term discomfort.
I have been advised that 10% to 12% of men experience moderate to severe chronic pain post surgery. While that number is high, it is lower than for those who have non-mesh repair. I have been advised that acute pain is normal during healing, but chronic pain is not normal. As I said, one example of pain management is to treat chronic pain by injecting local anaesthetic and steroid. Long-term discomfort or pain is fortunately rare, but can still occur in one in 20 inguinal hernia repairs. While this number is still concerning, and, I believe, too high, the risk is dependent on the circumstances of each case. For example, there is an increased likelihood of it where patients have small hernias and where the predominant symptom before the operation is pain. Patients present at the clinic with pain and continue to have the pain after the operation. Both these adverse outcomes—the severity and the longevity of pain—remind us that regrettably complications can arise when any person undergoes surgery.
Mrs Hodgson
What we are establishing is that there are still many unknowns with regard to the numbers and when the pain occurs. That is what we need to drill down on. The hon. Member for Burton said that his surgery has been totally successful, however many months it is since it took place. However, the problem is not just post-surgery. Often, as we have heard, people are fine for two or three years and then suddenly, “Boom!”—they are hit with whole host of pain and autoimmune reactions. We need to drill down on that when we are looking at the problem. Will the Minister commit to trying to use the data to do that?
Ms Dorries
I am hopeful that the Cumberlege report will touch on that area to some degree. I will study the report in some detail, as will officials in the Department, and we will decide where we go from it, but I emphasise that the alternative of not having the mesh repair is more dangerous and has more complications, as we know from the data, than having it.
Jim Shannon
To follow on from the shadow spokesperson’s question, has it been possible within the investigation and review to understand why the vast majority of people can have the operation without any side effects, while a large number of people do? There were 400 such people in Northern Ireland. If we take that population across the whole country, that means about 24,000 people across the rest of the United Kingdom, so the figures show a large number of people who have had problems. Is it possible to say why, or to investigate and ascertain why those problems take place, as they did in Australia?
Ms Dorries
We will take that question away. I will come back to the hon. Gentleman, because that is a detailed question with more complexity in it than I could answer today. For those people who suffer from pain, is it alleviated by the steroid and local anaesthetic injection? Are those numbers just people who present back once with pain, or do they go on to have chronic long-term pain, and, as the hon. Member for Washington and Sunderland West says, come back three or four years later? Some drilling down into that data is needed.
Work is under way both within and independent of Government to improve safety and how we listen to patients, in order to gather the information to work with. In July, we launched the patient safety strategy, which sets out the direction of travel for future patient safety. It was developed through speaking to not just staff and senior leaders but, importantly, patients from across the country. As much as it looks at system improvements, such as digital developments and new technologies, it also looks at culture, so that the NHS becomes ever more an organisation with a just culture of openness to concerns, whether they are raised by patients, family members or staff. Concerns of all kinds should be welcomed, valued and acted on appropriately.
We are also waiting to hear back from the independent medicines and medical devices safety review, which is led by Baroness Cumberlege. The review examines how the healthcare system has responded to concerns raised by patients and families around three medical interventions, one of which is vaginal mesh. To do so, the review has focused on meetings with a broad range of stakeholder groups; I think the hon. Member for Washington and Sunderland West may have attended one of those with her mother.
I close by acknowledging just how difficult the subject matter is. No one should suffer from chronic long-term pain without every effort being made to reduce it and find out why it occurs in the first place. This is not an easy subject for men who are suffering from ongoing pain to speak about. We know that men are always very reluctant to come forward and go to the doctors about anything. I pay tribute to the many impassioned contributions of the brave men who have allowed their stories to be told, who have visited their MPs and contributed, because men are not good at sharing information when it comes to their health.
As I mentioned earlier, however, it is vital that the use of mesh to treat hernias continues. It remains the best course of action for patients where the appropriate treatment pathway leads to surgery. As with all treatment, shared decision making should be central to this process. It is vital that we continually examine the evidence together on the best means of treatment. Decisions in healthcare are often about weighing potential benefits against risks, and I thank those in our healthcare system who strive always to offer us the best treatment possible.
Jim Shannon
It was the hon. Gentleman’s quotation, so I am just quoting him again. He has personal knowledge of what has taken place. Again, to be fair, his operation has been successful. The shadow spokesperson, the hon. Member for Washington and Sunderland West, brought a lot of information to the debate. The problems are really real.
We set out two subjects in this debate: No. 1 was awareness, which is important, but No. 2 was that everyone should understand, before they have the operation, what the implications could be. That does not mean that they will not go ahead with the operation, but it ensures that they understand it. The hon. Lady referred to the “devastating” effect that this can have on lives. It is not a quick or cheap procedure, either, and patient safety is critical.
I thank the Minister for her response. She first confirmed in her contribution that we are raising awareness, and secondly referred to a safety review. I appreciate that and understand why. That does not in any way dismiss—no one can dismiss—those problems that have arisen out of the hernia mesh operations in men as not real. I ask her, if she has the opportunity, to perhaps look at the Australian investigation, although maybe she has already done so.
Jim Shannon
There we are; the Minister is ahead of me there. Well done. That investigation might give us some ideas for what we could do here as well.
I also thank the hon. Member for Burton (Andrew Griffiths), as always when he turns up, for his contribution. I know many people who have had the operation successfully, but my job here is to bring to the attention of the Minister and this House the many others who live with the mental, physical and emotional problems. That is what this debate is about. I thank everyone for their contributions, and I thank you, Mr Hanson, for chairing the meeting admirably, as you always do.
Question put and agreed to.
Resolved,
That this House has considered hernia mesh in men.
Suicide Risk Assessment Tools in the NHS
Nadine Dorries Excerpts(5 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
It is a pleasure to serve under your chairmanship, Sir Christopher. After 10 years of being a Chair myself, I hope I do not incur your wrath today.
I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for securing this important debate. It is an honour for me to take up the position as Minister with responsibility for suicide prevention. My predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), did a commendable job when she held this position and I am determined that we continue to do whatever we can to reduce the devastating impact of suicide.
I offer my sincere and heartfelt condolences to the family of my hon. Friend’s constituent. I welcome Robert Bellerby to Westminster Hall and thank him for coming today. These will continue to be difficult times for the Bellerby family. I know from personal experience how devastating it is to lose someone you love and someone who is close to you through suicide. It is inspirational for me to see the courage and determination of those, such as Mr Bellerby, who manage to bring about positive action from such tragic circumstances. By their actions, Mr Bellerby and others like him will help to prevent others from going through the same deep and lasting loss.
I will now turn to the specifics raised by my hon. Friend about the use of risk assessment tools for patients at risk of suicide. He raised the specific case of Andrew Bellerby, who sadly died in 2015. I understand that at the time of Andrew’s attendance at hospital, it was practice at the Sheffield Health and Social Care NHS Foundation Trust to use a crisis triage rating scale tool. It was used to assess Andrew before he was discharged. Sadly, he took his own life shortly after. The trust conducted a serious incident review to learn the lessons from this tragic case.
It is clear that the care Andrew received leading up to his death was not satisfactory, and I understand that a comprehensive action plan was developed and fully implemented by the trust following the serious incident review. I have also been reassured that the trust has stopped using the crisis triage rating scale tool, following a report published by the national confidential inquiry into suicide and safety in mental health in 2018, which recommended that the risk assessment tools should not be used as a way of predicting future suicidal behaviour.
I recognise and share my hon. Friend’s concerns about the use of risk assessment tools across the wider NHS. He is right that guidelines published by the National Institute for Health and Care Excellence make clear recommendations that NHS professionals should not use risk assessment tools and scales to predict future suicide or repetition of self-harm, or to determine who should be offered treatment and who should be discharged. Each NHS trust is responsible for the care it delivers and the safety of its patients. but NICE guidelines are clear on the use of risk assessment tools, and we expect the NHS to implement the guidelines. Clinical guidelines represent best practice and should be taken fully into account by clinicians.
The national confidential inquiry into suicide and safety in mental health has published “Safer services: a toolkit for specialist mental health services and primary care”, which presents 10 ways to improve safety. NHS England has supported all mental health trusts to access the toolkit, which includes guidance for trusts on the use of risk assessment tools and highlights NICE guidance. The toolkit specifically states:
“All patients’ management plans should be based on the assessment of individual risk and not on the completion of a checklist.”
The hon. Member for Blaydon (Liz Twist) was absolutely right that the situation should be put in its context as it presents at that moment. Everything, including the history of physical and mental health, should be considered when assessing and evaluating a patient when they present with a potential suicide.
Ms Dorries
I am delighted to inform the hon. Lady that just this week, NHS England has written to all mental health trusts to make clear that they should be adhering to NICE guidelines on the use of risk assessment tools. My hon. Friend the Member for Thirsk and Malton mentioned a trust that is still using the old method. As a result of this debate, we have ensured that the letter is going out to tell NHS trusts that they should not be using the tools any longer and should be implementing the NHS guidelines.
Jim Shannon
I congratulate the Minister on her appointment. When intervening on the hon. Member for Thirsk and Malton (Kevin Hollinrake), I referred to the 20% increase in suicides in Northern Ireland. I did so because it is factually correct, and because in Northern Ireland we have a policy and strategy in place to address those issues. Has the Minister, in her short time in her role, had the opportunity to discuss those matters with, for instance, the Northern Ireland Department of Health?
Ms Dorries
I am afraid I must disappoint the hon. Gentleman. This is my third day in, and I have not yet had a chance to discuss Northern Ireland in detail, but as a result of his intervention I will ensure that we do that, and it will be on tomorrow’s agenda.
The letter that NHS England sent out highlights the report from the University of Manchester on “The assessment of clinical risk in mental health services”, and asks trusts to ensure that their risk assessment policies reflect the latest evidence from the university, as well as best practice. I am pleased that NHS England and NHS Improvement have committed to working with trusts to improve risk assessment and safety planning as part of future quality and safety work on crisis care and suicide prevention.
My hon. Friend the Member for Thirsk and Malton asked specifically about the role of the Care Quality Commission in ensuring that trusts are adopting best practice in respect of risk management processes. The CQC has assured me that risk management processes are a key feature of every CQC inspection. I hope that that assurance from the CQC, along with the letter that NHS England sent out this week, will go some way to reassure my hon. Friend.
Kevin Hollinrake
I am sure that the work that the Minister has already done to raise the issue with trusts is very positive news for the family. On the basis that people do not do what is expected but what is inspected, it is good to hear that some processes are already in place in the CQC. Will new processes be added? Presumably checks were happening when the situation occurred, so we need something else to ensure that best practice is properly adopted.
Ms Dorries
If I may continue my speech, I hope that I can reassure my hon. Friend on that point.
The Government are committed to a culture of openness, honesty and transparency in the NHS. The legal duty of candour means that trusts need to be open and transparent with patients or their families when something appears to have caused, or could lead to, significant harm. Trusts could face action from the CQC if they are seen to be failing to comply with that duty. I think that some good news will come out later in the year that will hopefully reassure my hon. Friend regarding a new culture that will develop within the NHS to encourage staff and clinicians to be more open about incidents as they happen, so that they share information and we can learn from such incidents.
Our national learning from deaths policy has introduced a more standardised approach to the way that trusts review, investigate and learn from deaths. The national guidance on learning from deaths, published in 2017, is about supporting trusts to become more willing to admit to and learn from mistakes, so that they reduce risks to future patients and prevent tragedies from happening in the first place. The guidance is clear that trusts must engage meaningfully and sensitively with bereaved families and carers as part of that process. I hope that, as a result of those measures, what the Bellerby family went through in 2015 will never be experienced by another family. To support our national policy, the CQC has strengthened its assessment of learning from deaths by trusts.
I will talk about what we are doing to reduce suicides across the NHS more widely. People in contact with mental health services account for around a third of all suicides in England, and arguably some of the more preventable ones. The overall suicide rate among people in contact with mental health services has reduced significantly over the last decade, but numbers remain too high. We must not lose sight of the fact that nobody under the care of NHS services should ever lose their life as a result of suicide. At the start of 2018, we therefore launched a zero suicide ambition, starting with mental health in-patients, but asking the NHS to be more ambitious and look to expand it to include all mental health patients.
Andrew Griffiths (Burton) (Con)
I know it is only the Minister’s third day, but the thing that we ask for more than anything else in a Minister is for somebody who cares about their portfolio. It is clear that my hon. Friend really cares about this issue. I am not unique in this, but as one of the few Members who has used NHS mental health services, I can attest to the real value and life-saving contribution that they make. I commend her decision to have that aspiration for zero deaths from suicide in the NHS.
In my constituency, there were 10 suicides last year. That is 10 families ripped apart and hundreds of lives broken as a result of those tragic decisions. Key to a brilliant service is the number of NHS nurses out in the community. Will the Minister, as she develops in her role, look at the numbers on the ground, so that we can be sure that everybody in our constituencies has access to mental health nurses, who can save lives?
Ms Dorries
I hope that I can reassure my hon. Friend on some of those points as I whizz forward. We have asked all mental health trusts to put zero suicide ambition plans in place. As already outlined, NHS England is providing funding for suicide prevention to every local area, which includes investment in a national quality improvement programme to improve safety and suicide prevention in mental health services across the NHS.
We are also investing £2 million in the Zero Suicide Alliance, which aims to deliver an NHS with zero suicides across the system and in local communities. It is doing that through improved suicide awareness and prevention training, and developing a better culture of learning from deaths by suicide across the NHS. In June, the then Prime Minister announced that we would encourage all NHS staff to undertake the Zero Suicide Alliance training, which makes all NHS staff more aware and gives them a basic understanding of how to recognise when somebody may be in the space of wanting to take their own life.
My hon. Friend the Member for Thirsk and Malton may be aware that yesterday the Office for National Statistics published the final suicide registrations data for 2018. Concerningly, there were substantial increases in the suicide rate amongst the general population, following three consecutive years of decreases. The latest figures are disappointing, but reinforce why suicide prevention continues to be a priority for the Government and for me personally.
Experts are clear that we need more data to draw firm conclusions from the latest data, and we will continue to work closely with academics and other experts to consider the data in more detail. There has also been an issue over the past two accounting periods surrounding coroners and the way the reporting of suicides takes place. We continue to take action to reduce the devastating impact of suicide. Every local area has a suicide prevention plan in place, and we are working with the local government sector to ensure the effectiveness of those plans. NHS England is also continuing to roll out funding to every local area to support suicide prevention planning.
We are continuing to improve mental health services. Under the NHS long-term plan published in January, there will be a comprehensive expansion of mental health services, with an additional £2.3 billion in real terms by 2023-24. Crisis care is a key element of the plan, which commits to ensuring that by 2023-24 anyone experiencing a mental health crisis can call NHS 111 and have 24/7 access to the mental health support that they need in their community.
We will set clear standards for access to urgent and emergency specialist mental health care. That will be supported by further mental health crisis care services by 2023-24, including 100% coverage of 24/7 crisis provision for children and young people, 100% coverage of 24/7 crisis resolution, and home treatment teams operating with best practice by 2021 and maintaining coverage to 2023-24. We are also investing £249 million to roll out liaison mental health teams in every acute hospital by 2020, which I hope addresses the question my hon. Friend the Member for Thirsk and Malton asked earlier, to ensure that people who present at hospital with mental health needs get the appropriate care and treatment that they need.
To conclude, I again extend my sincere and heartfelt sympathies to the Bellerby family and friends. I assure them that we are doing everything that we can to prevent further suicides, as we understand their devastating impact on families and the communities affected. I thank my hon. Friend again for raising this very important issue. I would be happy to meet him, and Mr Bellerby and his family, to discuss their concerns in more detail.
Question put and agreed to.
Children with Life-limiting Conditions
Nadine Dorries Excerpts(5 years, 9 months ago)
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Several hon. Members rose—
Ms Nadine Dorries (in the Chair)
I will impose an informal five-minute limit on speeches. Obviously, if Members go over the informal limit, I will have to impose a formal four or three-minute limit, so if everybody would realise that and be courteous, that would be great.
Fiona Bruce (Congleton) (Con)
It is humbling to follow the hon. Member for Swansea East (Carolyn Harris). I want to put on record my respect for her campaigning on this and other issues, and for my constituency neighbour and hon. Friend the Member for Eddisbury (Antoinette Sandbach).
I commend the work of the Donna Louise Children’s Hospice in Stoke-on-Trent, which provides children’s and young people’s hospice services across Staffordshire and south-east Cheshire. It has written to me this week—given that time is short, I will pass the Minister a copy of the letter after the debate. It talks about the quality of palliative care as patchy:
“The way in which NHS CCGs and local authorities plan, fund and monitor children’s palliative care in hospitals, children’s hospices and the community represents”—
as we have heard—
“a postcode lottery. Staffordshire has no coherent plan and this is reflected in the poor financial support the Hospice receives from local commissioners. Donna Louise receives 8.9% of its income from the NHS”.
The hospice calls on the Government and NHS England
“to consider appropriate mechanisms to bridge the children’s palliative care accountability gap.”
I want to spend most of my speech talking about an issue that I know is uncomfortable for some people to hear about. For that reason, I am delighted that you are in the Chair, Ms Dorries, because you have spoken about this issue on a number of occasions. Many families face a difficult decision when a child in the womb is diagnosed with a life-limiting or life-threatening condition. This is not a small issue: in 2017 there were a total of 3,314 ground E abortions on the grounds that the child was diagnosed with a substantial risk that, if born, they would suffer from physical or mental abnormalities, such as being seriously handicapped. Parents have to make really agonising decisions.
A few years ago, I held an inquiry in this place on the difficult situations that parents face when their child is diagnosed in this way and they have to consider an abortion. We took evidence from dozens of witnesses. Some had come under huge pressure to have an abortion, and the support they were given to consider keeping their baby was very limited. Many told us that they were steered towards an abortion, and they felt like the medical profession was irritated by them. Many felt like they were given no information on the support they might get; often the best information they got was through contacting charities, which could put them in touch with parents who were bringing up children—often very successfully. Those children brought great joy to their families, but the medical professionals did not give the families the information they needed to make a decision that was right for them. Some told us that all they received was a leaflet telling them how to have an abortion. The mothers who had kept their children, even if it was for a very short time, felt like they could grieve and care for their children in a way they had not been able to do otherwise. One mother had to have an abortion with her first baby and then decided she would keep the second, even though she knew the condition was life-limiting. She felt like there was a much better outcome for her and her family’s going through the grieving process.
The inquiry made a series of recommendations—I will pass a copy to the Minister because time is very short. I hope she will consider them and respond to me. Many people generally find this issue a very difficult one to address, as do—I am sorry to say—Ministers. Many of the recommendations in that report, which was published a few years ago, are still valid today. We recommended that guidelines for the medical profession should include training for obstetricians, foetal medicine specialists and midwives on the practical realities of the lives of children who have such conditions, so that they can better advise parents and give them better information when they make this difficult decision. One parent summarised what many others reported:
“Guidelines and standards need to be set in place”
so that all hospitals can meet a certain standard. Can the Minister assure me that she will look at our report and perhaps produce guidance to ensure that all mothers feel like they can make a genuinely informed decision when they are carrying a baby with a life-limiting condition? Does she agree that we ought to provide much better information, so that parents in such circumstances can make an informed choice?
Ms Nadine Dorries (in the Chair)
I am afraid that I will now have to put a formal time limit of four minutes on Back-Bench speeches.
Julie Cooper
I totally agree, and I will come to that point in a moment.
The average NHS contribution to children’s hospices is only 9%. Recent additional costs relating to the implementation of the NHS staff pay award and extra pension costs have pushed many hospices into a dire financial position, with closure a real possibility. Where hospices are forced to close, the NHS is left to fund the entire cost of health and social care for those children and young people.
In that context, the announcement by NHS England in December of £25 million of extra funding for children’s hospices was extremely welcome. However, children’s hospices do not know how to access that extra funding. Derian House Children’s Hospice in Chorley, which currently supports 12 families from my constituency, told me this week that there is no clarity about how that newly committed funding can be accessed. As many Members mentioned, since the publication of the NHS 10-year plan there has been confusion about what exactly has been promised.
The Minister will be aware that the 10-year plan promises that, over the next five years,
“NHS England will increase its contribution by match-funding clinical commissioning groups (CCGs) who commit to increase their investment in local children’s palliative and end of life care services including children’s hospices.”
Does she agree that that is confusing, and will she clarify the following points? Will the £25 million promised in December be only for children’s hospices or for a wider group of children’s palliative care services? Can she guarantee that, as a result of the long-term plan, the £11 million children’s hospice grant will be protected and increased to reflect the growing demand and complexity of care provided by those lifeline services? The total spend on children’s palliative care in hospices, hospitals and the community currently exceeds £25 million, so the promised funding could be viewed—I am sure this is unintentional—as a cap on NHS spending on children’s palliative care. In the light of that, can she reassure me that the NHS will indeed provide additional funding for children’s hospices?
I turn briefly to the financial pressures that parents of children with seriously ill children often experience. The 2018 “Counting the cost” survey of families who provide long-term care for a disabled child found that many experienced huge financial difficulties. A third of all families surveyed said they had additional costs of more than £300 each month. Some 46% of families had been threatened with court action for non-payment of bills. That is hardly surprising given that 87% of the families surveyed were unable to work because of their caring commitments.
CLIC Sargent has highlighted that children suffering with cancer often have to travel longer distances than adult patients for regular treatments, placing a significant additional financial burden on parents already coping with so much. Will the Minister commit to introducing a package of financial support that includes a children and young people’s cancer travel fund for parents who care for children with life-threatening diseases? Will she also spare a thought for bereaved parents and accelerate the introduction of the children’s funeral fund that so many Members have requested?
In conclusion, I ask that the Minister answers the specific points that I and other hon. Members have raised, and commits to implementing a comprehensive strategy that provides a consistent standard of joined-up, adequately funded children’s palliative care that has full parity with adult care.
Ms Nadine Dorries (in the Chair)
Minister, will you leave one minute at the end for Mr Shannon to wind up?