Gay-to-straight Conversion Therapy

Norman Lamb Excerpts

Wednesday 20th November 2013 Westminster Hall

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

Thank you, Mr Hood. I congratulate the hon. Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing the debate and thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for her contribution, which I was pleased to hear as well. I found myself agreeing with the vast bulk of what has been said and with the interventions that have been made—in fact, I agreed with everything that has been said.

Personally, I find the practice utterly abhorrent and it has no place in a modern society. That is my personal view, and many of the questions that have been asked are questions that I have asked officials about the powers that might be available. If hon. Members would welcome it, I would be very happy to meet with all of them or a group of them to discuss the matter further. That is an open offer, which I make genuinely.

The Government have a proud record of supporting the rights of lesbian, gay and bisexual people. Most recently, we witnessed and welcomed the enactment of the Marriage (Same Sex Couples) Act 2013. Our support for the legislation demonstrates absolutely our belief that extending the right to marry to lesbians and gay men is part of recognising that loving and committed relationships and families in modern Britain come in all shapes and sizes and should be celebrated.

[Sandra Osborne]

Is the Minister aware that today in the Scottish Parliament the same-sex marriage Bill is being introduced? Does he not think that that is ironic, given that we are discussing this matter?

[Norman Lamb]

I thank the hon. Lady for that intervention, and I note her point. Being lesbian, gay or bisexual is not an illness—it is sad that we need to state that, but it needs to be stated. It is not an illness to be treated or cured. Way back in 1973, the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders. Thankfully, the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992; there was quite a long delay before that happened. Therefore, we are concerned about the issue of so-called gay-to-straight conversion therapy.

The Department of Health has received 15 or so letters in the past few months about the issue. All but one of those letters have been supportive of gay people and against the notion of gay-to-straight conversion therapy. That surely reflects the fact that most people in society today are far more relaxed and understanding about people’s sexuality than they ever were in the past.

We are not aware that the NHS commissions this type of therapy. It is completely inappropriate for any GP to be referring a patient for such a thing. It is unacceptable that that should happen through someone working in our national health service.

[Geraint Davies]

Is the Minister aware that the number of people who go to psychotherapists has tripled under this Government to 1 million? Given that number and given that we have heard evidence about people being referred by GPs, is it not now high time for regulation to stop abuse and potential abuse?

[Norman Lamb]

I will come to that. I do not think that the fact that numbers have increased can be blamed on this Government.

We are not aware that the NHS commissions this type of therapy. In my replies to correspondence, I have confirmed that the Department of Health does not recommend the use of conversion therapy—I have made clear today my personal view on that—and it is not a National Institute for Health and Care Excellence-recommended treatment. That is self-evident. Furthermore, the main national professional associations for psycho- therapy have declared that they regard conversion therapy as wrong.

In February 2010, the UK Council for Psychotherapy said:

“UKCP does not consider homosexuality or bisexuality, or transsexual and transgendered states, to be pathologies, mental disorders or indicative of developmental arrest. These are not symptoms to be treated by psychotherapists, in the sense of attempting to change or remove them.

It follows”—

this is very important—

“that no responsible psychotherapist will attempt to ‘convert’ a client from homosexuality to heterosexuality”.

Similarly, in September 2012, the British Association for Counselling and Psychotherapy set out the following:

“The…Association…is dedicated to social diversity, equality and inclusivity of treatment without discrimination of any kind. BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’ therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality.”

In January 2013, the British Psychological Society published a position statement that opposed any psychological, psychotherapeutic or counselling treatments or interventions that view same-sex sexual orientations as diagnosable illnesses. It declared:

“This includes freedom from harassment or discrimination in any sphere, and a right to protection from therapies that are potentially damaging”—

that point was made by hon. Members—

“particularly those that purport to change or ‘convert’ sexual orientation.”

This issue is clearly causing a great deal of concern in the House, and rightly so. The hon. Member for Ayr, Carrick and Cumnock, as well as sponsoring this important debate, tabled an early-day motion in June. It called on the Government to take steps to ban gay conversion therapy and to investigate NHS links to conversion therapists. Several hon. Members present have referred to that motion and put their names to it.

The hon. Member for Swansea West (Geraint Davies) tabled a second early-day motion, calling on the Government to regulate counsellors and psychotherapists. There have also been a number of parliamentary questions on the issue. As hon. Members will know, the hon. Member for Swansea West has also introduced a private Member’s Bill seeking regulation of therapists. That is scheduled for Second Reading this Friday.

The Government have already said that there are no plans at this stage to introduce statutory regulation of psychotherapists. We do not believe that regulation would necessarily prevent this type of counselling in any case, as it would not depend on the type of therapy offered.

The Command Paper entitled “Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers”, which we published in February 2011, sets out the Government’s vision for the future of work force regulation. That paper makes clear our continuing view that, although statutory regulation is sometimes necessary, it is not always the most proportionate or effective means of assuring the safe and effective care of patients or social care service users. That is why we provided powers to the Professional Standards Authority for Health and Social Care in the Health and Social Care Act 2012.

The Professional Standards Authority oversees the work of the health care profession regulators, including the Health and Care Professions Council. Those powers facilitated the establishment of voluntary registers for unregulated health care professionals and health care workers in the UK, social care workers in England and certain students.

The accredited voluntary registration scheme to which I am referring is not a form of regulation, nor is the PSA a regulator. To be accredited, organisations must provide evidence to the PSA that they are well run and they require registrants to meet high standards of personal behaviour, technical competence and, where relevant, business practice, but the scheme does not endorse any particular therapy as effective and it makes it clear that accreditation does not imply that it has done so. However, organisations seeking to be accredited can set their own rules about what therapies their members can or cannot offer.

As accredited voluntary registration appears to be gaining momentum and is proportionate to the risk, we believe that statutory regulation would not be appropriate and the costs to registrants or the taxpayer could not be justified. This is not to say that we are ruling out statutory regulation for this group for ever. We will continue to assess the need for it. I give an absolute assurance about that.

This is not to say that lesbians, gay men and bisexual people cannot seek counselling or therapy because they are distressed about a particular aspect of their sexuality—that is very important—or that a therapist should not try to help their patient with whatever is causing them distress, which may involve helping them to come to terms with their sexuality, family arguments over their sexuality, or hostility from other people. Supporting people through aspects of their lives that are difficult or challenging is a large part of what therapists do. I think that my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) made that point in his intervention.

We want to minimise the risk that lesbians, gay men and bisexual people who seek counselling about their sexuality will face therapists attempting to change their sexual orientation because the therapist considers that being gay is wrong. That, of course, is completely unacceptable. That is why Department of Health officials last week met representatives from the UK Council for Psychotherapy to discuss a way forward on this important and sensitive issue. Officials will work in partnership with the council in the following ways.

First, the UK Council for Psychotherapy has agreed to draft, in consultation with the other relevant professional bodies, a public statement on conversion therapy that provides information and outlines the views held by those organisations. That is incredibly important. Once produced, that statement will be widely publicised and placed on relevant websites to ensure that individuals seeking a counsellor or therapist will be aware of those bodies’ views on gay conversion therapy.

Secondly, the Department of Health will host a round-table event in the spring to which it will invite relevant individuals and organisations in order to discuss ways to achieve greater quality and consistency across the profession in general, as well as on this specific issue. Thirdly, and subject to the progress of the private Member’s Bill, the Department will consider writing to statutory regulators, setting out key principles, to be agreed with the professional bodies.

In addition, although we are not aware of such therapies being commissioned by the NHS, my officials will explore with NHS England what actions it can take to ensure that clinical commissioning groups are not commissioning them locally. That is one of the issues that I am happy to discuss with hon. Members. I totally agree that it is not something that public money should have anything to do with.

I hope that I have assured those who have spoken passionately and persuasively in today’s debate that the Government are listening and taking action. I repeat my offer to meet hon. Members. We have a lot to be proud of. The UK is once again recognised as No. 1 in Europe on lesbian, gay, bisexual and transgender equality by the International Lesbian and Gay Association, and we continue to make great strides forward on equality. I hope that that reassures hon. Members both that this Government are strongly committed to advancing lesbian, gay and bisexual equality and that we are taking the issue of gay conversion therapy extremely seriously.

Hearing Loss in Adulthood

Norman Lamb Excerpts

Tuesday 12th November 2013 Commons Chamber

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

It is a pleasure to serve under your chairmanship for the first time, Madam Deputy Speaker. I congratulate the hon. Member for Nottingham South (Lilian Greenwood) on securing the debate and championing this cause. I will state at the start that I am very happy to maintain a dialogue with her on this, because she has made a powerful case and clearly a lot of progress could be made not only by the Government, but across the health and care system. I am happy to assist in that regard. I also pay tribute to my hon. Friend the Member for Eastbourne (Stephen Lloyd), who has done a lot of work in championing this cause, as the hon. Lady mentioned, and the Ear Foundation for its work on this important issue.

The hon. Lady made a good case for why this is so important. She talked about the importance of basic communication and the fact that hearing loss can affect mental health as well as physical health and lead to withdrawal from social activities. She talked about the cost to society, the impact on employment and the fact that there is poor deaf awareness among health professionals and that better training is needed. I absolutely agree with her on all those points.

Over 10 million adults in England are living with hearing loss. Some of them will have been among the one in 700 babies in England born with hearing loss, but many will be among the growing number who develop a hearing impairment during their lifetimes. For some people that will be the sort of age-related hearing loss that many of us will experience as we grow older and that will become increasingly common because of our ageing population, but for many others hearing loss is acquired and should therefore be avoidable.

The World Health Organisation considers half of all cases of hearing loss to be preventable—for example, by immunisation, early treatment or reducing exposure to noise. In fact, it identifies exposure to excessive noise as the major avoidable cause of permanent hearing impairment worldwide. In developed countries, it is at least partially responsible for more than a third of all hearing impairments. As a result of the UK’s ageing population, the impact of working with noisy machinery and exposure to loud music and other loud noises, the World Health Organisation predicts that by 2030 there will be an estimated 14.5 million people in the UK with hearing loss, and adult-onset hearing loss will be among the UK’s top 10 disease burdens. That demonstrates the scale of the concern.

We have to take hearing loss seriously, which is why we are currently looking to develop the action plan on hearing loss, which the hon. Lady mentioned, so that we can achieve better outcomes for all those with hearing loss and related conditions. The action plan will identify key actions that will make a real difference in improving health and social care outcomes for children, young people and adults with hearing loss and generally improving the hearing health of the population.

The Department of Health is engaging with a range of organisations in developing this action plan, and as Baroness Jolly mentioned, we aim to publish it as soon as possible. I will get back to the hon. Lady with an indication of the likely publication day. It is time that we set a target date and then focused minds on getting it published.

[Jim Shannon]

We have a UK-wide diabetes strategy, and in my intervention on the hon. Member for Nottingham South (Lilian Greenwood) I suggested a UK-wide strategy on deafness as well. Will the Minister consider that?

[Norman Lamb]

My responsibilities stretch only to England, but clear co-ordination and joint working with the devolved Administrations absolutely make sense on an issue that transcends borders, so I agree with the ambition that the hon. Gentleman sets.

This cannot just be about prevention because that is not always possible; it is also about dealing with the consequences of hearing loss. The Government are committed to delivering health outcomes that are among the best in the world for people with hearing loss. We are developing measures to identify those with hearing loss as early as possible, including the roll-out of a national hearing screening programme for newborn babies that enables the early identification of deafness, providing a clear care pathway for services and allowing parents to make informed choices on communication needs.

Today, however, we are focusing on adults with hearing loss. I realise that there is currently considerable interest on hearing loss screening for adults, which the hon. Lady mentioned. The UK National Screening Committee advises Ministers and the NHS in all four countries on all aspects of screening policy. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. In 2009, the committee recommended that routine screening for adults’ hearing loss should not be offered because of a lack of evidence to warrant such a screening programme. However, as part of its three-year review policy cycle, the committee is reviewing the evidence for a national adult hearing screening programme. A public consultation will be held shortly and details will be available on the committee’s website. I encourage the Ear Foundation and many others to contribute to that consultation.

We welcome the recent report by the Ear Foundation, which clearly sets out the benefits of cochlear implants for children and adults. Abigail’s story, as told by the hon. Lady, demonstrates what a massive impact that can have on an individual’s life. It completely transformed her life, and no doubt that experience is repeated very many times around the country. The report will be of enormous use to NICE if it decides to update the technology appraisal that it published in 2009. I encourage the Ear Foundation to engage with NICE. I am sure that it is already in touch, but it is very important for it to provide any emerging evidence to NICE to help it to update, if necessary, the guidance provided on implants.

A large number of services are already commissioned for people with hearing loss, and a number of specialist centres in England provide implants for children and adults. It is important that GPs understand the criteria for referral, as well as the obvious benefits of this technology for people with hearing loss. That touches on the hon. Lady’s point about the importance of health professionals, whether GPs or anyone else in the health system, gaining a better understanding of the potential for this technology. There have been considerable improvements to services for people with hearing loss in recent years, including reduced waits for assessment and treatment to within 18 weeks—a significant advance.

[Lilian Greenwood]

I thank the Minister for his positive response to the questions that I posed. What will he personally do to ensure that such training and updating on hearing technologies by health professionals and GPs takes place?

[Norman Lamb]

I do not want to give a bland answer, but I take this issue very seriously. I have noted what the hon. Lady has said. Health Education England is responsible for the training of health professionals. I will pursue the hon. Lady’s point and would be very happy to report back to her.

There is now a greater choice of hearing aid services through independent high street providers—which are easily accessible for members of the public—and the new any-qualified-provider commissioning model offers even greater choice and convenience.

We have also asked NICE to produce clinical guidelines and related quality standards for the assessment and management of adult-onset hearing loss and guidelines for the assessment and management of tinnitus, which the hon. Member for Strangford (Jim Shannon) has referred to in the context of Northern Ireland. Those guidelines will be scheduled into NICE’s development programme over the coming months.

Enabling those with hearing loss to have the same opportunities and to live as independently as everyone else is essential. It is therefore vital that public services are geared up to help and support them. Public authorities, including health and social care bodies, are required by the Equality Act 2010 to make reasonable adjustments for disabled people, to ensure that they can use a service as close as is reasonably possible to the standard usually offered to everyone else. The Department of Health has agreed to explore with its partners what more can be done to accommodate the communication needs of disabled service users.

Work is going on across the Government to support the needs of people with hearing loss. The Department for Transport’s Access for All programme has delivered access improvements at 1,100 stations since 2006, including induction loops at ticket offices and help points on platforms. The hon. Member for Nottingham South mentioned the specific problems that people face when travelling and the anxiety caused by worrying about not hearing an announcement. There will be facilities on platforms for deaf users and systems that show train information on LED display screens. Last year, a further £100 million was announced to extend the programme until 2019.

Courthouses have been provided with hearing loops since December 2012. In policing, police link officers for deaf or hard-of-hearing people use and are qualified in British sign language and work with the community to raise awareness of how to access the police. Staff in Derbyshire have passed level 1 of their training with Action on Hearing Loss, and they accepted an Action on Hearing Loss charter mark, “Louder than Words”, recognising the efforts they have made to communicate more effectively with deaf people. I pay tribute to those parts of the public sector that have made the effort to improve the way in which they communicate. Far more needs to be done, but they are the exemplars that others should follow. For those who do not use BSL, text relay, which enables deaf and hard-of-hearing people to text the police, is in place in most emergency call centres.

I hope that those examples give a flavour of some of the work that is being done across the public sector and confirm the Government’s continued commitment not only to preventing, but to treating hearing loss and promoting and protecting those affected.

[Lilian Greenwood]

Will the Minister give way?

[Norman Lamb]

The hon. Lady is just in time.

[Lilian Greenwood]

Before the Minister concludes his speech, will he address my specific suggestion to establish a lead commissioner for audiology, to ensure that there is a focus on good commissioning across the health service?

[Norman Lamb]

I will discuss that suggestion with NHS England, because that is its responsibility under the new design of the health system.

Let me end by congratulating the hon. Lady again on raising this really important issue, and I repeat that I am happy to engage with her to try to make progress.

Question put and agreed to.

Pharmaceutical Price Regulation Scheme

Norman Lamb Excerpts

Wednesday 6th November 2013 Written Statements

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

My right and noble Friend the Under-Secretary of State for Health, Earl Howe, has made the following written ministerial statement:

I am pleased to announce today the heads of agreement on the new pharmaceutical price regulation scheme (PPRS). The PPRS is a voluntary scheme agreed between the Department of Health, acting on behalf of the UK Government and Northern Ireland and the branded pharmaceutical industry, represented by the Association of the British Pharmaceutical Industry (ABPI), under section 262 of the National Health Service Act 2006.

The current voluntary pricing scheme, the 2009 PPRS, will terminate on 31 December 2013. Following negotiations, the Department of Health and the ABPI have reached agreement on the outline terms of a new scheme which will operate for five years starting from 1 January 2014.

The new scheme will provide an unprecedented level of certainty on almost all the NHS branded medicines bill. The bill will stay flat over the next two years and will grow slowly after that. The industry will make compensating payments to the Department of Health if NHS spending on branded medicines exceeds the agreed growth rate. The agreement therefore provides stability and predictability to both the Government and the UK pharmaceutical industry, supporting the industry’s global competitiveness. It will encourage the use of innovative and effective new medicines in the NHS.

Alongside these arrangements, the National Institute for Health and Care Excellence (NICE) will continue its work to introduce the broader value assessment for new medicines covered by value-based pricing. We have listened to feedback from patients’ groups that they would welcome further opportunities to feed into the development of the new arrangements for value assessment and have agreed that NICE will carry out a frill public consultation before implementing the methods for wider value assessment in autumn 2014. Publication of the complete 2014 PPRS is expected later in the year.

In addition to the agreement, I am also publishing today the Government response to the consultation on the statutory pharmaceutical pricing scheme, which contained proposals to strengthen the scheme, and align it more closely to the PPRS. This scheme provides an important safeguard for the NHS, controlling the prices of branded medicines sold to the NHS by pharmaceutical companies that decide not to join the voluntary PPRS. Through this response document, we are setting out the changes we will be making, including introducing a 15% price cut on branded medicines sold by statutory scheme companies. We will shortly be introducing amending regulations to effect these changes.

Copies of the heads of agreement, the response to the consultation and the related impact assessment have been placed in the Library. Copies are available to hon. Members from the Vote office and to noble Lords from the Printed Paper Office.

Release of Bodies from Hospital

Norman Lamb Excerpts

Wednesday 30th October 2013 Westminster Hall

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

I congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing the debate and raising an issue of extreme sensitivity. I can imagine the enormous distress for the family involved. As the intervention suggested, at a moment of grieving, no family would want to have to cope with this situation. Let me be very clear that the practice that my hon. Friend describes, whether it is a one-off or more widespread, is completely unacceptable. That message has to be disseminated to the entire system, because respect for families who have suffered a bereavement and respect for the deceased person are of paramount importance. I am therefore very grateful to my hon. Friend for raising this subject and enabling me to respond. I am grateful also to her constituent, Mr Williams, for raising the issue with her so that it could be exposed in Parliament.

Each year, more than 500,000 people die in England and Wales, with local mortuary and bereavement services working hard to ensure that during the period of grief, the bereaved are supported and due regard is given to their individual needs. I think that in the vast majority of cases, that happens and people are treated with the respect that they deserve.

The current guidance, entitled “When a Patient Dies: Advice on Developing Bereavement Services in the NHS”, which was published by the Department in 2005, highlights the importance of involving relatives in decisions about care after death, but does not set out specific guidelines on the release of bodies. In addition, the document entitled “Care and Respect in Death: Good Practice Guidance for NHS Mortuary Staff”, which was issued in 2006 and to which my hon. Friend referred, states:

“Where families have individual, cultural or religious preferences concerning the storage, handling, transportation or presentation of the deceased person, these need to be carefully documented and accommodated wherever possible.”

Let me now deal with the legal context. A dead body is a possible source of infection, so society requires that the law balances the need to give regard to the respectful disposal of the dead with the need to ensure the protection of public health. Hospitals have put in place procedures to try to manage a number of competing demands and legal requirements in a way that causes the least difficulty for the vast majority of people and that allows coronial, health-and-safety and other requirements to be met.

The law does not recognise—my hon. Friend made this point—a dead body as someone’s property, but it has been held in case law that the executors, administrators or other persons charged by law with the duty to dispose of the body have a right to its custody and possession until it is disposed of. In straightforward cases, in which the coroner is not involved, the duty to dispose of the body can rest with a range of individuals or organisations, with an established order of precedence. The executor of a will, not the next of kin, has the primary claim to possession.

Generally, when a person dies, an early priority for the family is to arrange the final disposal of the person’s body. Lawful disposal may occur once a registrar has received a satisfactory medical certificate of cause of death and subsequently issued a certificate of disposal, commonly known as the green form, or the coroner issues a certificate of disposal where a death has been referred for a coroner’s investigation. My hon. Friend has clearly done an enormous amount of research on this subject. I am very impressed by the amount of knowledge that she has acquired.

The person with the authority to administer the estate of the deceased person has the right to possess the body in order to arrange disposal of the body— the funeral. The green form is one of the pieces of documentation required to allow a funeral to proceed and is often passed from the family to the funeral director. However, it is not a legal requirement for an individual to produce a green form in order to collect the body from the hospital. In practice, many hospitals appear to treat the green form as the key documentation for body release. I understand that hospitals do that to confirm that the death is not a coroner’s case. Potentially, up until the green form is issued, a registrar could refer a death to the coroner because new information relating to the death has come to light and the registrar finds themselves under a duty to report the death to the coroner. The other reason for some hospitals insisting on seeing the green form is, understandably, for reassurance that the body is being released to the right person. That is key to the case that my hon. Friend has raised today.

In the context of about 500,000 deaths a year, my Department has had very little representation to suggest that local hospital procedures for the release of bodies are causing difficulties. I am interested in this. My understanding is that the Department has not had many representations, yet my hon. Friend’s assertion, which I take seriously, is that the practice could be more widespread. We need to understand whether that is the case. At the moment, there appears to be a lack of evidence, but if she or anyone else is aware of more evidence, we need to hear about it. This is a very important matter.

[Caroline Nokes]

On that specific point, which relates to the concern the hon. Member for Strangford (Jim Shannon) raised earlier, one issue my constituent raised was that the practice occurs at a time of bereavement and grieving, and consequently people are far less likely to complain, because they wish to move on and get on with their lives and the grieving process. That point is important, because we simply do not know the extent of the problem. My constituent is concerned because his mother-in-law’s body was released with no paperwork whatsoever, so the practice could be far more widespread than we will ever know, because it is unreported.

[Norman Lamb]

I thank my hon. Friend for that intervention. I appreciate that if such practices have occurred, families will in many cases feel reluctant to raise a complaint. None the less, we need evidence, so if people are aware of such activities, I encourage them to come forward.

In some areas, funeral directors had experienced delays in collecting bodies from hospitals due to the documentation required by the hospital, which relates to the problem my hon. Friend raises. A national representative body of funeral directors reported its members’ concerns to officials in my Department. Following the concerns being raised with us, my Department re-circulated advice on the release of bodies to the NHS in a 26 October 2012 edition of The Week bulletin, to highlight to NHS trusts that having sight of the green form was not a legal requirement for the release of bodies, that holding bodies can cause unnecessary delays, and informing them of proposals to consult on a draft body release form as part of the consultation on death certification reforms. I want to reinforce the point that a delay in the release of the body can also be distressing for loved ones, who are going through bereavement. Ensuring that the process works efficiently is incredibly important.

Some hospitals have been using their own body release forms, which is the impression I received from Bristol. The situation my hon. Friend describes would not have happened if the hospital had followed its own procedures. Such forms are used to facilitate release of the body, and that is potentially a way forward to resolve the problem. Officials have worked with key partners, such as mortuary technicians, bereavement services and funeral directors, to develop a draft body release form designed to provide the NHS with reassurance about the appropriateness of releasing a body, which they currently achieve via the green form. My Department will seek views on the merit of such a form, and the contribution of key groups, such as funeral directors associations, will be vital. The consultation will make further relevant proposals, and when it is published in due course, I will welcome my hon. Friend’s participation.

My hon. Friend made detailed points about the legislation and raised concerns about the potential conflict between legislation and guidance and concerns about employees seeking to comply with the law while under pressure to release a body. It is important that we respond to all the points she made, and I will ensure that we do so. I end by again thanking her for raising this important, sensitive issue. Whether this practice is a one-off or more widespread —whatever its prevalence—it is important that it is dealt with properly and that this sort of thing never happens again.

Question put and agreed to.

Mental Health Act (Post-legislative Scrutiny)

Norman Lamb Excerpts

Friday 25th October 2013 Written Statements

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

We have today laid before Parliament “Post-legislative Scrutiny of the Mental Health Act 2007: Response to the Health Committee of the House of Commons” (Cm 8735).

The response addresses the specific recommendations in the Committee’s report. These include (in the Mental Health Act 1983) the important issues of independent mental health advocate services, supervised community treatment, places of safety and (in the Mental Capacity Act 2005) the deprivation of liberty safeguards.

The Department will feed consideration of all the recommendations into future work programmes, including the revision of the “Code of Practice Mental Health Act 1983” in 2014.

I would like to put on record my thanks to the Committee for their thoughtful comments.

In-patient Mental Health Services (Children and Adolescents)

Norman Lamb Excerpts

Wednesday 23rd October 2013 Commons Chamber

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

I congratulate the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) on securing the debate. It brings back happy memories of the times when I used to shadow him in his previous job as Secretary of State. He raises an incredibly important issue. Let me say right at the start that I would be very happy to meet him, together with his constituent and NHS England. Having read the brief and listened to him, I am conscious that there is some confusion about the number of children involved, the acuity of their condition and so forth. I want to get to the bottom of that and understand exactly what is going on to ensure that we get the right facilities available for children in his part of the country.

The right hon. Gentleman talked in his introduction about the reduction in the number of in-patient mental health beds. That, of course, is a trend that has been going on for the past two decades, under his Government and this Government, and rightly so. There has been a substantial shift towards early intervention and care in the community, rather than institutional care. However, there is still a long way to go. Too many people with mental health issues stay too long in in-patient beds, which tend not to be a therapeutic environment, much as we would want them to be. On the whole, however, the trend has been in the right direction, as the right hon. Gentleman would probably agree.

The right hon. Gentleman also mentioned the data issue. I completely agree. Mental health issues have been a data-free zone. He talked about the loss of one particular data set, but in the mental health sector we struggle in an absence of data and of understanding of the evidence about what interventions work effectively. That has to be addressed and it is being addressed.

The right hon. Gentleman mentioned what I said about the institutional bias. There is absolutely an institutional bias against mental health issues. One example is the 18-week wait for treatment for physical health conditions, which his Government introduced—rightly so, because people were waiting for far too long. But people with mental health conditions were left out. No one with such conditions has any understanding of when they should be seen; there is no access standard. There is no requirement for someone with an eating disorder, which can kill, to be admitted for care and treatment within a defined period. I am determined to end that because such provisions drive where the money goes in the NHS.

The right hon. Gentleman mentioned that, as a result of decisions of commissioners around the country, funding for mental health conditions has gone down whereas that for physical health conditions has gone up. That is because of how money works in the NHS. We have to end that institutional bias. I suspect that we completely agree about that.

I fully appreciate the right hon. Gentleman’s concerns about child and adolescent in-patient mental health services, and I am aware that this is not the first time he has raised them. We have corresponded about the issue and can consider it further when we meet. Caring for children and young people with mental health problems is incredibly serious and it is a priority for the Government. We want to achieve parity of esteem between physical and mental health, which should be regarded as just as important as each other. Historically, that has not been the case—that is not a party political point, but a fact.

The Health and Social Care Act 2012 sets out the equal status for mental and physical health. Our overarching goal is to ensure that everyone who needs it has timely access to the best care and treatment available. We have made improving and treating mental health conditions a key priority for NHS England. One of the 24 objectives in the mandate, which sets out the Government’s priorities, is to put mental health on a par with physical health and close the health gap between people with mental health problems and the population as a whole.

Why do those with mental health problems die years earlier than those with physical health problems? We will hold the NHS to account for the quality of services and outcomes for mental health patients through the NHS outcomes framework, which at last assesses what results we are achieving for individuals as a result of the money spent. There is a strong desire for change across the health sector—and the justice sector as well.

We are working with a range of agencies and representative organisations to develop a single national crisis care concordat. Crisis care for children and adults is simply not acceptable in too many parts of the country. What we are trying to achieve together is a joint statement of intent and common purpose—an agreement about what each service everywhere should do, and when it should do it. It will help to ensure that people who find themselves in need of immediate support for their poor mental health get the right services when they need them and the help they need to move on from their episodes of personal crisis.

Of course, our aim must be to support our children and young people with mental health problems in the community wherever possible. I absolutely share the right hon. Gentleman’s concern and that of other Members who talk about children being sent long distances from home. As a parent, I would feel exactly the same. The most important thing is that such children should be in the right facility with the right care and treatment. As we are trying to care for more youngsters in the community, the specialist units become more specialist. It is not right for a child with an eating disorder, for example, to be put into an in-patient unit that does not specialise in eating disorders. Getting the right facility is crucial, but that sort of distance causes me great concern, and I accept that we need to address it.

[Alan Johnson]

Will the Minister give way?

[Norman Lamb]

Of course, very briefly.

[Alan Johnson]

I thank the Minister, and I am pleased that he is going to meet me and my constituent. Will he confirm the consultation process set out in the 2006 Act? Will he also say something about the tariff, which I am told by the clinical commissioning group in the East Riding would prevent the provider from accepting in-patient care, even if it were restored, because it means that it loses money?

[Norman Lamb]

. The right hon. Gentleman raises the tariff, and that is what I want to get to the bottom of. I genuinely want to understand the issue and reach a conclusion on it, and I hope that by meeting we will be able to do that.

We want to ensure excellent child and adolescent mental health services facilities across the country. That is why we are investing £54 million over four years in the children’s and young people’s IAPT—improving access to psychological therapies—programme. That will drive service transformation in CAMHS, giving children and young people improved access to the best mental health care by embedding evidence-based practice which has been absent in these services until now and making sure that they use session-by-session outcome monitoring. The IAPT programme is fundamental to the success of our mental health programme. Our children’s IAPT programme is ambitious in its objectives. Its aim is service transformation with an emphasis on evidence-based practice and a rigorous focus on frequent session-by-session outcome monitoring. It differs from the adult IAPT programme in working across existing community-based CAMHS rather than creating new services.

[Mr Bradshaw]

I am sorry to have to say this, but the Minister’s speech is just waffle. Will he accept that the Government’s reorganisation of the national health service has led to confusion as to who is responsible for the interface between tier 3 and tier 4 mental health services for young people? Will he look at the cases I have raised with the Secretary of State of young people from my constituency being sent to Newcastle—the north-east of England—and all over the country, and being sent to adult wards, in breach of the law?

[Norman Lamb]

I do not think it has been waffle at all. I have tried to answer very directly the concerns that have been expressed. I will absolutely look into the cases that the right hon. Gentleman raises. When I hear reference to children being placed in adult services, I find that as unacceptable as he does. I want to understand how it has happened and bring it to an end. NHS England is carrying out a review over a three-month period to assess the facilities for tier 4 services to ensure that sufficient services are available in all parts of the country. Because of the nature of the specialism, they cannot be in every town and city, but they must be within reasonable reach. That is exactly what the review is seeking to undertake.

[Alan Johnson]

I have just heard in the last 10 minutes that the staff of the West End unit have been told that its day services will close on 20 December. There has been no consultation and it is the first I have heard of it. Will the Minister look into that immediately? This is no longer about in-patient mental health services; it is about all mental services in Hull and the East Riding.

--- Later in debate ---

[Norman Lamb]

Yes, of course I will look into it. It is the first I have heard of it, and I need to understand the full facts. It is important to say that the centre was only occasionally used for overnight stays, as I think the right hon. Gentleman recognises. That was certainly the case in 2012-13. Let us establish the facts. I am very happy to meet him, together with NHS England and his constituents, so that we can get to the bottom of this and provide proper answers on an issue that causes real concern not only to him but to me and to his constituents.

Question put and agreed to.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Nick de Bois (Enfield North) (Con)]

13. What progress has been made on implementation of the Barnet, Enfield and Haringey clinical strategy.

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

The local NHS continues implementing the Barnet, Enfield and Haringey clinical strategy, which was approved by the Secretary of State in September 2011 following a review by the independent reconfiguration panel. Enfield council has recently issued an application for judicial review of local clinical commissioning group plans. Unfortunately, I am therefore limited in what I can say in that regard.

[Nick de Bois]

Department of Health Ministers know well of my continued opposition to the decision. However, does the Minister understand that it is crucial that the investment in primary care first promised by the Secretary of State in 2008 is in place before the reconfiguration takes place? Will the Minister confirm that patients will have access to a doctor on the Chase Farm site 24/7?

[Norman Lamb]

First, I acknowledge my hon. Friend’s campaigning on behalf of his constituents—he has worked very hard. I understand that, as part of the case for change and for reconfiguring health services at Chase Farm hospital, a doctor will be available to see patients at Chase Farm 24 hours a day, seven days a week. However, given that my right hon. Friend the Secretary of State for Health has been named as a defendant by Enfield council in the judicial review, it would not be appropriate for me to comment further at this time.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Does the Minister recognise that the question is not if the changes take place, but when? Does he recognise that all my local doctors say that it is in the best health interests to get on with the changes, not least given that the £200 million invested in the new North Middlesex hospital in Enfield was dependent on them?

[Norman Lamb]

I recognise my hon. Friend’s work in this regard. Decisions should be based on clinical judgment and the views of local doctors are important. He draws attention to a fantastic new facility. I pay tribute to everyone who has worked to achieve it. It will serve the local community well.

[Priti Patel (Witham) (Con)]

14. What measures are in place to hold doctors accountable for their mistakes.

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

T3. Wirral council has said that anybody who wants to be involved in providing social care must show their commitment to the ethical care charter. Will the Minister congratulate leading councillors Phil Davies and Chris Jones on taking this initiative, which includes a move away from zero hours contracts? Will he say specifically what conversations he has had with the Local Government Minister and with Treasury Ministers about making sure that each and every local authority has sufficient funds to fulfil their legal obligations in care services?

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

I pay tribute absolutely to that local initiative, which is exactly the sort of direction we are going in. I have made the point several times that we cannot get great care on the back of exploiting workers. The idea that people should not be paid while they are travelling from one house to another is, in my view, unacceptable. When employers and care providers breach the minimum wage legislation, we should be absolutely clear that that is completely unacceptable. To ensure great care, the Government are introducing in 2015-16 the £3.8 billion integrated transformation fund, which will pool resources between the NHS and social care to ensure that we shift the focus to preventing ill-health and deterioration, and I think that that can make a real difference.

[Chris Skidmore (Kingswood) (Con)]

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation?

--- Later in debate ---

[Jason McCartney (Colne Valley) (Con)]

T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review.

[Norman Lamb]

I agree that we must learn the lessons. NHS England is responsible for conducting the new review into congenital heart disease services, and it is committed to conducting a review that is robust, transparent and inclusive, in the interests of delivering high-quality, sustainable services for all patients.

[Jessica Morden (Newport East) (Lab)]

T9. When the minimum wage increased recently, a working carer on 15 hours a week contacted me because she found herself to be 85p over the threshold for carers allowance, meaning that she would lose £259 a month. What work is the Minister doing with other Departments to ensure that carers are not penalised for caring and working?

[Norman Lamb]

First, we should applaud the work of the many carers around the country who are doing absolutely invaluable work. It is obviously important to ensure that the policies of one Department do not have an adverse impact on the work of another, and I will be happy to look into the case that the hon. Lady has raised.

[John Glen (Salisbury) (Con)]

T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally.

Personal Health Budgets

Norman Lamb Excerpts

Tuesday 8th October 2013 Written Statements

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

In October 2011, the Government announced that people receiving NHS continuing health care (NHS CHC) would have the “right to ask” for a personal health budget (PHB), including a direct payment, subject to the results of the PHB pilot programme. This commitment was confirmed in November 2012, following the publication of the independent evaluation of the pilot programme.

This “right to ask” for a PHB will be enshrined in secondary legislation and will take effect in April 2014. These amendments make it clear that clinical commissioning groups will need to develop the capacity and capability to deliver PHBs, as it imposes an obligation to give serious consideration to requests for PHBs. The “right to ask” for a PHB is not the same though as an automatic entitlement to a PHB. There will be some people for whom a PHB is not appropriate because, for example, their existing package of care is the best way of managing their needs.

I am today announcing to the House that the position is to be strengthened for those groups who gain the “right to ask” for a PHB in April 2014, as from October 2014 this group will further be given the “right to have” a PHB. A “right to have” will guarantee that people in receipt of NHS CHC and those transitioning in from social care or children’s services will have continuity of care in the services they receive. Those already on NHS CHC will be able to continue to access the services they are familiar with as they will be in control of how their budget is spent and have the confidence to exercise choice. Similarly, those who are new to NHS CHC, those who transition in from social care budgets or those who transition from children’s services will be able to continue to access the services they are accustomed to without the fear that this power to choose will be taken away from them when they move to a new package of care. There will continue to be people for whom PHBs are not appropriate but by giving a “right to have” we will ensure that they will only be declined on clinical or financial grounds which are deemed to make a PHB unviable.

I believe that this policy will ensure stability and continuity for those who need it most and go further towards our goal of providing greater personalisation within our NHS.

Spinal Cord Injuries

Norman Lamb Excerpts

Wednesday 4th September 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the first time, Dr McCrea.

I congratulate the hon. Member for Wrexham (Ian Lucas) on securing this debate and on his persistence in pursuing the matter. I have noted what he said about his frustration in securing meetings with a couple of Ministers. At least we have had the chance this afternoon, albeit interrupted, to debate this important issue, and I am more than happy to talk to him if there are issues arising from this debate that he wants to pursue further.

The hon. Gentleman makes the point that how care is administered is incredibly important to the individual, and he also mentioned the profound impact that spinal injury has on the whole family and everyone involved. He talks about the emergence of a postcode lottery, but if we are honest with ourselves, the postcode lottery has always existed to some extent. The interpretation of rules has always varied somewhat across the country. Indeed, the Coughlan case was brought because of a failure to apply rules properly. I will return to that in due course, but it is essential that all areas of the country apply the rules properly, according to the guidelines, and apply the precedent that has been set.

I also pay tribute to the important work of the all-party group on spinal cord injury, which has had a major impact on issues affecting the estimated 40,000 people with spinal cord injury in the United Kingdom and Ireland alone. Every eight hours, a new person is told that they will never walk again, which is a stark reminder of the scale of spinal cord injury.

Thankfully, research is making important strides in developing new techniques to help spinal cord injury patients regain as much function and independence as possible. In 2011-12, the Medical Research Council spent £900,000 on research directly related to spinal cord injury. The Government also fund a wide range of research relating to spinal injury, and through the National Institute for Health Research, the Department of Health is funding research on spinal cord injury in biomedical research centres in Cambridge and London.

There is an increasing range of guidance available to provide advice on the causes, treatment and management of spinal cord injuries. Stakeholders such as the Spinal Injuries Association and Aspire provide information and support services for patients and their families following spinal injury, and we should pay tribute to the work of those organisations. In February 2008, the Royal College of Physicians published a guideline for GPs and other health professionals involved in the management of adults with spinal cord injury in the acute hospital setting. I am confident that that range of guidance will be useful for educating people and, critically, professionals on spinal injuries and how to manage them.

More work is taking place to develop guidance for the treatment of those with spinal injuries. The Department has asked the National Institute for Health and Care Excellence to produce guidance on the assessment and imaging of patients at high risk of spinal injury. NICE is developing five pieces of guidance relating to trauma, with expected publication dates in June and October 2015. Each piece of guidance will focus on a different aspect of trauma care. The guidance on spinal injury assessment will form one part of the wider work and is expected to be published in May 2015.

The hon. Gentleman appropriately raised NHS continuing health care for individuals with spinal cord injuries. NHS continuing health care is a package of health and social care that is arranged and funded solely by the NHS for individuals outside the hospital setting who have complex, ongoing health care needs. It is important to say that eligibility for NHS continuing health care is dependent not on an individual’s condition or diagnosis—it is important to maintain this point—but on the individual’s specific care needs. That must be appropriate, so that what is assessed is what the individual needs.

The assessment for NHS continuing health care is complex and involves a multidisciplinary team co-ordinated by the relevant clinical commissioning group looking at an individual’s needs across 12 care domains and assessing how those needs interact. The process determines whether individuals have what is called a primary health need. If they do so, they will be entitled to continuing health care.

The hon. Gentleman specifically referred to concerns about specialist involvement in continuing health care assessments. The national framework, which underpins the assessment and decision making for NHS continuing health care, makes it clear that someone with specialist knowledge is involved in the process, with other highly skilled professionals, such as doctors, nurses, social care staff and therapists. If that is not happening in an area, that is a failure to follow the national framework and should be challenged. I am interested to hear about cases in which that is not happening, because corners cannot be cut—things should be done properly. He made an important point.

The family or representative may also be involved, to ensure that a holistic picture of the individual’s needs is properly identified. After all, the family probably knows best about what the impact really is.

Individuals receiving NHS continuing health care will have their case reviewed three months after the initial decision and annually thereafter. It is important to remember that the focus of the review is not only whether the individual remains eligible, but whether their needs are being properly met and the package of care remains appropriate. Let me be clear, however, that an individual must be kept fully informed about the process and any proposed change to the care arrangement.

The hon. Gentleman expressed concerns about refusals of NHS continuing health care or the package being drawn too narrowly, suggesting that the Coughlan judgment was not being followed and that cases more serious than the Coughlan one were being refused—I think I have put that correctly, from what he said. I again make the point that if any areas are failing to follow the national framework, that must be challenged. I appreciate that families may not always understand or know how to go about challenging, or what they are entitled to, but we all have responsibility to disseminate that message and to encourage people to challenge decisions that cannot be justified.

[Ian Lucas]

The Minister is being very constructive in his response. Is there any process for monitoring the decisions? Organisations such as the Spinal Injuries Association can bring individual cases forward, but there needs to be some sort of system to ensure that the rules, which I am grateful that the Minister is stressing today, are being enforced as a matter of course.

[Norman Lamb]

The hon. Gentleman makes a fair point. I was about to say that I will ask NHS England to provide me with an assessment of how the work of CCGs complies with the guidelines. The very fact of that request for information will help focus minds and ensure that things are being done properly.

I am aware that there are some concerns about how autonomic dysreflexia is reflected in NHS continuing health care assessments. It is unique to spinal cord injuries and should always be treated as a medical emergency. The needs of individuals experiencing autonomic dysreflexia are to manage both the risk of episodes occurring and the risks involved if and when such episodes occur. Such risks, and therefore the needs, vary from one individual to another. It would be relevant to establish whether the individual has signs and symptoms of an advancing episode or whether the episodes are random and unpredictable.

It has been suggested that more people with spinal injuries are being placed in nursing home settings, rather than being offered a care package in their own home. The national framework is clear that NHS continuing health care packages should be as far as possible personalised—designed to meet that individual’s needs—and that the individual’s wishes should be taken into account. It is our hope that personal health budgets—a concept developed under the previous Labour Government, but strongly pursued under this Government—will give people more personal control over their care.

We recognise that it is more efficient for people with long-term conditions such as spinal cord injuries to have control over their own budget for health and social care, because they are less likely to duplicate services or to choose ones that are not right for them. Beyond being efficient, however, it is simply what we should be doing: we should be putting the individuals in charge and allowing them to determine their priorities. On that basis, CCGs are already able to offer personal health budgets to people on a voluntary basis, if they consider that it is cost-effective and will improve the individual’s quality of life.

We have also brought in legislation that will allow CCGs to offer direct cash payments as a way of managing personal health budgets. However, to make personal health budgets more of a reality for people, we have put measures in place to ensure that CCGs go further than offering them only on a voluntary basis. As of April 2014, those receiving NHS continuing health care will have the right to ask for a personal health budget, including a direct payment. Using a personalised care planning process, personal health budgets help people choose how to meet their health needs in ways that work for them.

I have just set out how the process for NHS continuing health care is intended to work. Let us not pretend, however, that it works perfectly in every case—it clearly does not. I am delighted that the Spinal Injuries Association continues to have a strong presence on the NHS national continuing health care stakeholder group. It is important that its voice and that of the people it represents are heard.

Eligibility for NHS continuing health care depends on a needs-based assessment. Therefore, some individuals will not be eligible, but they must still receive the appropriate level of care and support. Disjointed care is a source of complete frustration for patients and staff alike. To stay relevant to changing needs, different parts of the NHS and other organisations such as social services have to work more effectively together to drive joined-up care.

The first NHS mandate sets out a requirement to provide

“care which feels more joined-up to the users of services”,

and which

“ensures people experience smooth transitions between care settings and organisations”.

That is vital, and there is a total focus in Government on integrating and joining up care around the needs of the individual patient. On that basis, we have asked NHS England to make huge efforts to focus on delivering integrated care and support to improve outcomes for patients and for people who use those services.

I thank the hon. Gentleman for securing the debate. The issues that we have discussed this afternoon are important, because of their impact on people who have sustained a spinal injury which in itself is completely life changing. We must ensure that the care and support systems work to meet their needs and to enable the best possible quality of life and outcomes for those individuals.

Question put and agreed to.

Parliamentary Written Answer (Correction)

Norman Lamb Excerpts

Tuesday 3rd September 2013 Written Statements

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

I regret that the written answer given to the right hon. Member for Mid Sussex (Nicholas Soames) on 27 June 2013, Official Report, column 344-45W, contained some incomplete figures in the table.

It has been brought to my attention that the information provided in the original answer did not contain secondary care figures for December 2012. The table below shows the correct figures. The revised answer is as follows:



Expenditure by national health service trusts in London, as defined by the former London Special Health Authority (SHA), is provided for both anti-retroviral HIV medicines and anti-cancer medicines.



London generally has a larger proportion of its medicines costs going through hospitals than other SHAs as patients from areas surrounding London are likely to travel to London hospitals for some treatments.