Women’s Mental Health

Debate between Nadine Dorries and Andrew Griffiths

Thursday 3rd October 2019 Commons Chamber

[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.

Hernia Mesh in Men

Debate between Nadine Dorries and Andrew Griffiths

Thursday 5th September 2019 Westminster Hall

[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.

--- Later in debate ---

[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.

Suicide Risk Assessment Tools in the NHS

Debate between Nadine Dorries and Andrew Griffiths

Wednesday 4th September 2019 Westminster Hall

[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.