Covid-19 Update

Nusrat Ghani Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I remind the hon. Gentleman that the Government have already announced the biggest catch-up fund for electives that the country has ever seen in order to deal with that challenge.. There is an extra £2 billion for the second half of this year and a minimum of £8 billion over the next three years, and the NHS is working on a detailed plan which will be published as soon as it is ready.

[Ms Nusrat Ghani (Wealden) (Con)]

The Health Secretary should be very proud of our world-leading vaccination programme, and I join the Secretary of State in sending those who are anxious the message that they should come forward and get their vaccinations.

This morning, breakfast telly was being broadcast from the Buxted Medical Centre, a GP surgery in my constituency, where huge anxiety was being expressed about how NHS staff would cope with delivering the vaccinations. I am extremely anxious about the statutory instrument that is mandating vaccinations for NHS staff, because I believe it means that 126,000 of them will leave the sector. Is this the right decision, when NHS staff are already saying that they are working all the hours God gives?

[Sajid Javid]

We will debate the SI in the House, and I shall be happy to talk more about it then, but I think that the number to which my hon. Friend referred is the number of people whom the NHS estimated to remain unvaccinated at the time when the Government said they were going ahead with the SI. I am pleased to inform her that since then the number has fallen. Tomorrow I will come to the House with the latest figure that we have, but it is improving all the time. When we introduced a similar measure in the residential care home sector, we saw the number of unvaccinated people fall day by day as more and more of them had positive engagement and took up the offer of a vaccine.

David Fuller Case

Nusrat Ghani Excerpts

Monday 8th November 2021 Commons Chamber

[Sajid Javid]

I would expect that many of those steps may well be in place in many NHS trusts. The purpose of the NHS writing to all trusts is to ensure that the kinds of steps that I set out earlier, and others, are in place, so they are following the current rules and guidance that are set out by the Human Tissue Authority. What we also need to do is determine whether the current rules and guidance are right in the light of these appalling crimes and whether we need to go much further than that. That is also the purpose of having an independent inquiry.

[Ms Nusrat Ghani (Wealden) (Con)]

Fuller’s vile and depraved acts are hard to comprehend, especially taking into account the number of victims and the fact that the crimes took place over such a long period of time. My thoughts are with the families of Fuller’s victims as they come to terms with the news that they have been told. I am grateful for the inquiry; we need to understand how access was made available to Mr Fuller. May I push the Secretary of State a bit further, especially on family liaison officers? Will he provide assurances that all the victims’ families have that access for as long as they need it and can access mental health services for as long as they need to? Will he provide some assurances that, as far as he is aware, all the families of the victims have been contacted to date? And perhaps he can offer some assistance to the staff of MPs who are dealing with constituents going through this, so that we can make sure that we are offering the most sensitive advice and support possible.

[Sajid Javid]

My hon. Friend is absolutely right to make those points, and I can give those assurances. The police have informed my Department that all the families of all the victims have been contacted. They all have family liaison officers. That support and other support, such as counselling and mental health support, if required, and the 24/7 telephone line that I referred to, will remain in place for as long as is necessary. Indeed, if she and other Members of Parliament who have constituents who are affected think that there are other ways to provide support, of course we would be willing to do that.

Covid-19 Vaccinations

Nusrat Ghani Excerpts

Monday 20th September 2021 Westminster Hall

[Ms Nusrat Ghani (in the Chair)]

Before we begin, I encourage Members to wear masks when not speaking, in line with current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated and entering and leaving the room.

[Elliot Colburn (Carshalton and Wallington) (Con)]

I beg to move,

That this House has considered e-petitions 575801 and 577842, relating to Covid-19 vaccination.

It is a pleasure to serve under your chairmanship, Ms Ghani. I am glad that we have another opportunity to discuss vaccinations in this House. I thank the NHS, pharmacists and volunteers in Carshalton and Wallington, and across the UK, for making our vaccination programme such a huge success. I particularly thank Reena from SG Barai Pharmacy in Carshalton and Wallington for administering my covid-19 vaccinations.

I welcome the Minister to her place; I believe this is the first debate she is responding to as Minister. I have always found her to be nothing but courteous and friendly, so I wish her all the very best in her new role.

I draw the House’s attention to the Government’s responses to the petitions, which set out clearly that they are thinking carefully about such matters as certification and vaccine status, and are considering all issues prior to making a decision. I am sure the Minister will want to elaborate on them in her response to the debate, so I will not steal all her material. This debate gives us the opportunity to discuss vaccinations once again, so I want to use it to urge everyone to book their slot for vaccinations as soon as they possibly can. I particularly welcome the news today that we are beginning our booster jabs programme, which I am sure the Minister will want to touch on.

Covid has not gone away. Although we are unlocking and rediscovering many of the freedoms that we have sacrificed over the past 18 months, people are still being hospitalised and dying from coronavirus. The data speaks for itself: the majority of those hospitalised and dying from covid-19 have not been fully vaccinated. It is clear that by getting vaccinated, we are protecting not only ourselves but others, and are playing our part in bringing an end to this pandemic.

Vaccines truly are a marvel of modern medicine. We can be proud that they were discovered by a Brit, Edward Jenner, who demonstrated that a mild infection with a cowpox virus conferred immunity against the deadly smallpox virus. Cowpox served as the natural vaccine for smallpox until more modern vaccines were brought out in the 19th century, which laid the groundwork for the system of vaccinations that we know today. Smallpox remains the only virus considered to be eradicated internationally since 1980.

Since Jenner’s discovery of vaccines as we know them today, vaccines have been developed and have helped to offer immunity to a whole range of virus, such as measles, mumps, rubella, influenza, tetanus, polio, diphtheria, yellow fever, rabies, hepatitis, poliomyelitis, meningitis, and so many more. It is easy, therefore, to take vaccines for granted, but I invite the House to consider how much of an impact they have had on the world. Those illnesses would once have struck dread, fear and anguish into the hearts of the patients who were diagnosed with them, yet today our lives are quietly unaffected by those horrors. We go about our day unworried by them, thanks to the seemingly simple concept of a jab that is over in a matter of seconds, which allows us to carry on our lives, protected and healthy.

These miraculous vaccines must pass extremely rigorous testing before they are licensed for use in the United Kingdom. According to the Oxford Vaccine Group, the following are just some of the stages that a vaccine has to go through before use: a literature review to look at what has been done before; a theoretical development or innovation, coming up with a new idea or varying an existing one; and laboratory testing and development, involving in vitro testing using individual cells and in vivo testing, which often uses mice. A vaccine must then go through three stages of human trials before licensing and reviews, and then continue to be monitored after their approval for wider use to take note of any new developments.

Covid 19 vaccines have been no different. They have had to meet the same testing criteria. Yes, there have been questions about speed, but Dr June Raine, chief executive of the Medicines and Healthcare Products Regulatory Agency, has explained perfectly clearly how the UK has been particularly able to approve this vaccine so quickly. So my message to anyone who still has apprehensions about getting their covid-19 vaccine is this: please, please speak to your GP or pharmacist to get the facts. That is an important point: speak to the professionals with the years of knowledge and training.

We have all had a bit of a laugh over the past week and a half about Nicki Minaj and swollen testicles—something that I never thought I would say in the House of Commons—but that story raises a very serious issue. Rates of vaccination drop as we go down the age groups, and it is important that the Government find ways to reach younger people and encourage them to protect not only themselves, but others around them, by getting the vaccine. That is especially the case when they are being fed misinformation, downright lies, and mad conspiracy theories by people with hidden agendas who are in the pockets of well-funded and well-organised anti-vax movements. I agree with Professor Chris Whitty that those people are preventing others from getting their potentially life-saving vaccine, and they should be utterly ashamed of themselves. My message today is to urge everyone to speak to their doctor and get themselves vaccinated in order to protect themselves and those around them, and help to bring an end to this awful pandemic.

--- Later in debate ---

[Jack Dromey]

My hon. Friend is absolutely right. Some of the propaganda that we have seen, including on the internet, is positively pernicious. If anyone is seduced into believing it and, as a consequence, catches covid and dies because they are not vaccinated, those responsible bear should bear a heavy burden for what they are doing. Everyone with power, including the internet companies, needs to be more proactive and dynamic in ensuring that shameful propaganda is not propagated on social media.

Over the past year, we have seen the tragic impact of coronavirus on our communities. I stress once again that it is absolutely vital that the importance of taking the vaccine is constantly emphasised. I think of Jane Roche in my constituency, who lost her father and, five days later, her sister to covid. Jane remains distraught to this day, one year on. People such as Jane know all too well just how important it is that vaccine uptake remains high, so that no one should suffer the grief that she has suffered. Like other hon. Members who have spoken in the debate, I therefore strongly encourage everyone to get vaccinated for their own protection, but also for that of the wider community.

The Labour party calls on the Government to make a more direct effort to vaccinate those from communities in which vaccination rates are low, particularly young people. I hope that in her response, the Minister will be able to update us on the Government’s efforts to tackle the problems of low uptake.

On vaccine passports, in relation to the petitions before us, we understand why the public might be confused or anxious about perceived discrimination against those that are not vaccinated. I have to say that the Government’s approach to covid passports has been chaotic at times. There has not been consistent clarity from Ministers about what vaccine passports are supposed to achieve, how they would work and what would be expected from the public, businesses and workers, and that meant we had a degree of chaos over the summer and no real preparation before the winter. Two weeks ago, the then vaccines Minister, the right hon. Member for Stratford-on-Avon (Nadhim Zahawi), stood before Parliament to confirm the introduction of covid passports and stress their importance; days later, the Secretary of State for Health and Social Care said that they had been scrapped. No matter the measures being introduced, businesses, workers and consumers need clarity from the Government, not conflicting messages and rapid U-turns. We have therefore repeated many times that we would not accept any certification or passport scheme that was vaccine-only.

The Welsh Labour Government have made some interesting progress on this very issue. They followed the data and applied a mandatory risk assessment that takes into consideration the full risk posed, and then recommends a range of mitigations on that basis. For large venues, crowded events and close-contact businesses, such as nightclubs, the NHS covid pass application is mandated for use; that means using familiar mitigations such as masks, social distancing and ventilation in most business settings, based on the risk level. Use of the NHS covid pass gives people the option to present a negative test result as an alternative to full vaccination.

We do not support the introduction of any scheme that provides access to a service for only fully vaccinated people. Free testing should therefore remain widely available so that we can identify and isolate the virus. The approach in Wales has been welcome in other respects, as it makes a clear distinction between venues such as local cafés on one hand and Wembley stadium on the other, where different mitigations for covid are needed.

We also do not support any potential covid pass scheme for access to essential services that does not get the balance right. That includes, but is not limited to, access to doctors and dentists, supermarkets and other essential retailers. We do not agree that vaccine passports should be used for day-to-day, routine access to the office, health services, dentistry or food.

On health and social care workers, we want everyone working in care homes to take up the vaccine—that is absolutely essential. The vaccine is safe and effective. I stress again: do not believe the sometimes poisonous propaganda of the anti-vaxxers. However, we do not support the case for compulsory vaccination. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes, which would have disastrous consequences for the quality of care.

Again, the UK Government should learn from the work done in Wales, which is running the fastest vaccination programme in the world, and has vaccinated a far greater proportion of its care staff than England. The Welsh Government have rejected compulsory vaccinations and have instead chosen to work closely with the care sector to drive up uptake, as well as valuing the workforce, including a proper pay rise. The Government should focus on driving up standards and retention of staff by treating care workers as the professionals they are, with improved pay, terms and conditions and training. We need all care homes and care workers to have proper personal protective equipment, regular testing and good training.

We are now approaching what is likely to be one of the most challenging winters that the national health service has ever faced, and the top priority must be to protect it. We urgently need a plan from Government that sets out the direction of travel in the next stages. Any plan for the winter period must, first, get vaccination rates up in areas where uptake is low; secondly, outline how and by when vaccinations for children will be rolled out; thirdly, finally fix the issues of self-isolation and sick pay; fourthly, provide proper ventilation in schools and public buildings; and, fifthly, provide a clear plan for businesses, workers and consumers. Those are significant steps the Government could take to greatly improve the country’s response to coronavirus. I hope that when the Minister responds, she will be able to outline in more detail the Government’s plan to fix those problems.

Once again, as other hon. Members have done cross party, I emphasise the importance of vaccine take-up. Covid-19 vaccines have saved thousands of lives and been crucial in protecting the national health service. It is critical that we maintain the protection the vaccine affords and send a clear and unambiguous message to all that vaccines work, and that anyone who can, should receive the vaccine.

[Ms Nusrat Ghani (in the Chair)]

I now call on Minister Maggie Throup to respond, and welcome her to the Front Bench; I wish her well.

--- Later in debate ---

[Maggie Throup]

I thank the hon. Gentleman for the question. If he will excuse me, I have obviously been in post a short time. As I am led to believe, it is people who regularly go into care homes that will need this. It is not just restricted to the actual carers. If anybody needs to go into a care home in an emergency situation, that is a different scenario. If I may, however, I will clarify that after the debate.

Vaccine uptake nationally in the care home workforce is high, at 85.6% for first doses. This is in line with vaccine uptake in the general population. There is, however, significant variation at a regional, local and individual care home level. Vaccine requirements are designed to level up uptake in the care home workforce. While the majority of care home workers have been vaccinated, the latest published data as of 12 September highlighted that only 81.3% of older adult care homes in England were meeting the SAGE advice that 80% uptake of first doses among staff is the minimum needed to reduce the risk of outbreaks in these high-risk care settings.

While residents in care homes are some of the most at risk from covid-19, the responses to this initial consultation on care homes made a clear case for extending this policy to other settings where vulnerable people receive care and treatments. The Government are therefore seeking views on whether to extend vaccination requirements to other frontline health and care workers—those with face-to-face contact with patients and clients through the delivery of services, as part of a CQC regulated activity. Recent research has shown that people infected with both flu and covid-19 are more than twice as likely to die as someone with covid-19 alone and nearly six times more likely than those with neither flu nor covid-19, so vaccination requirements for both flu and covid-19 are being considered.

I trust that the debate will have helped to dispel some of the myths that hon. Members have raised about vaccinations, and will really reach out to the public to ask them, as colleagues have done, to go and get vaccinated to protect themselves and others. To conclude, I reassure the House that we are doing everything we can to widen and deepen our wall of defence that the vaccine provides. The ask of our NHS colleagues is challenging and complex, yet they have risen to this challenge and do it every day. Once again, I thank them for their dedication.

[Ms Nusrat Ghani (in the Chair)]

Thank you, Minister, and well done on your first time speaking from the Front Bench.

Menopausal Symptoms: Support

Nusrat Ghani Excerpts

Wednesday 9th June 2021 Westminster Hall

[Ms Nusrat Ghani (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. I remind Members participating physically and virtually that they must arrive for the start of the debates in Westminster Hall and that they are expected to remain for the entire debate. I remind Members participating virtually that they are visible at all times to us in the Boothroyd Room. If they have any technical problems, they must email [e-mail]. Those Members attending physically must clean their spaces before they use them and as they leave the room. Mr Speaker has stated that masks should be worn in Westminster Hall, unless you are speaking.

[Carolyn Harris (Swansea East) (Lab)]

I beg to move,

That this House has considered support for people experiencing menopausal symptoms.

It is a pleasure to be opening this important debate in person, Ms Ghani, and to serve under your chairmanship. I thank the Chamber engagement team for their support in creating a dedicated webpage for anyone impacted by the menopause to share their experiences with me ahead of the debate—this is a fantastic service available to us all in the House—and the responses that I have received have been honest, insightful and true examples of why we need to open up the discussion and remove the stigma that still surrounds the menopause. In total, 728 people responded to the public survey and I will share some of their experiences with Members later.

On World Menopause Day in 2018, I made a speech in the main House of Commons Chamber calling on the Government to commit to make a difference to the lives of all women experiencing symptoms of the menopause. At present, approximately 13 million of us in the UK are either perimenopausal or post-menopausal. That is almost a fifth of the entire population. In that debate back in 2018, I spoke of the need for changes in the curriculum to better educate our young people; improved public education to help women who are suffering and those closest to them; better training for GPs to ensure that women are correctly diagnosed and given the right treatments; and mandatory workplace menopause policies, so that women may continue to work through what can be the most difficult time of their lives.

With many pressure groups and the media now shining a light on issues to do with menopause, we are starting to talk about it more, but now we also need to start taking action. Education is key here, both public education—so that women understand what is happening to their bodies and feel confident in making informed decisions about the path they choose—and professional education, which is severely lacking.

A recent survey on menopause support revealed the shocking truth about training in medical schools. An astounding 41% of UK universities do not have mandatory menopause education on the curriculum. Menopause will, at some point, directly affect half of the population, and yet it is completed overlooked when training the people that we will all turn to for help.

Women are suffering unnecessarily, and while some barely notice any changes, for others the suffering is unbearable—stressful, debilitating and completely life-changing. Despite that, many doctors complete their training and leave university with absolutely no education about menopause at all. I am fairly confident that no other medical condition set to impact the lives of more than 50% of the population would be left out in that way.

The Royal College of General Practitioners states that menopause is included in the curriculum, although not mandatory or standardised. Bearing in mind that we know more than 40% are not providing mandatory training, however, women who are suffering and turn to their GP for help cannot be assured that the doctor they visit will be competent in recognising their symptoms, let alone to provide them with the treatment plan and medication they need. In our public engagement survey, Gillian shared her experience, saying that her GP told her to ask her mother as her experience would be the same:

“I walked out with a leaflet…no support, no advice, no understanding”.

Far too many women are still being misdiagnosed and prescribed anti-depressants, and they suffer extreme symptoms without the correct treatment and support. This needs to change. GPs should follow up-to-date guidance from the National Institute for Health and Care Excellence on the menopause and hormone replacement therapy, and they should recommend such treatment if it is appropriate. Sadly, far too many women are denied this path, because many doctors are unaware or ill informed. Even those who are lucky enough to visit a GP who recognises their symptoms and understands the benefits of HRT treatment still face barriers.

In Scotland and Wales, prescriptions are free to everyone, but unfortunately women in England are forced to pay £9.35 per item. For some, their treatment may include multiple items every time. Lisa responded to our survey by saying:

“Free HRT prescriptions are needed. I’m currently charged two prescription charges for one box of medication.”

Lesley said:

“It’s a process of elimination getting the correct medication. It’s so expensive and I have found it very difficult to pay for the prescriptions.”

That is not something to be taken lightly. It is not just the odd hot flush or moment of forgetfulness. Menopausal symptoms can ruin women’s lives, and until something is done to improve the standard of diagnosis and treatment, they will continue to ruin even more.

Women deserve so much better. They are giving up their careers and ending relationships because of the severity of their symptoms and the impact on their physical and mental wellbeing. It is no coincidence that suicide rates for women peak between the ages of 45 and 54, which is the average age that most women reach the menopause or experience perimenopausal symptoms. This cannot carry on. I do not want to be standing here in another two and a half years talking about the same things.

Education on the menopause, which is slowly being incorporated into the curriculum in secondary schools, is a positive step forward, but it is just one part of a much bigger picture. Public health guidance, standardised compulsory training for those in the medical professions, and fully funded HRT treatments and workplace policies need to follow. Women should not feel inferior or incapable of doing their job because of the effects of the menopause on their health and wellbeing, but, sadly, too many do.

The situation could be so easily rectified. Simple changes in the workplace, such as flexible working hours, relaxed uniform policies and adaptations to the working environment, could all make such a difference. Dinah talked about this in her survey response. She explained that in her workplace, she was

“surprised to find no menopause policy whereas we have policies for most conceivable events.”

She added that she told her manager about her menopausal symptoms and how she felt that they were interfering with her capacity to do her job. She said:

“I was offered no support, we just talked about how I could stop making mistakes.”

The Government have alluded to that in their call for evidence for the women’s health strategy. One of the areas being considered is maximising women’s health in the workplace, with menopause being one of the female-specific conditions mentioned that impacts on women’s participation in work. I urge anyone affected to complete the public survey before the deadline of 13 June, and details can be found on the Government website.

None of the things I have mentioned are big on their own. They are all easy to rectify, but the lack of them all is having a devastating impact on so many lives. We have the power to change that, and we must seize the opportunity. I plan to set up an all-party parliamentary group on menopause support over the coming months. I have already had colleagues from across the House express an interest in joining, and I would be delighted to hear from more MPs and peers—both male and female—who I know share my passion to make a difference.

Women should not be left to suffer through a lack of awareness, inadequate support or financial restraints. Every woman experiencing menopausal or perimenopausal symptoms should be confident that they will be able to access the right treatment and support in every aspect of their lives. Women deserve to see medical schools providing appropriate training so doctors can diagnose and prescribe appropriately. Women deserve to have mandatory menopause policies in their place of work. They deserve to be given the reassurance that they can access treatment without worrying about how to pay for it and they deserve to be assured of all the support and care that they need. Women have been suffering in silence for far too long. This debate has given them a voice. Now it is up to us to listen and act.

[Rosie Duffield (Canterbury) (Lab) [V]]

It is a pleasure to serve under your chairship for the first time, Ms Ghani. I thank my hon. Friend the Member for Swansea East (Carolyn Harris), the deputy leader of the Welsh Labour party, for securing the debate today and for all that she is doing to raise awareness of this and many other women’s health issues.

Menopause will affect the vast majority of women, with some experiencing menopause earlier as a result of cancer or other health conditions. I have friends who have gone through it who then have the added stress of having to explain to others why they are unable to have children, or to share their medical histories. There seems to be such a lack of awareness and understanding of issues around the menopause. It can still feel like a bit of a taboo subject.

The menopause is, of course, a women’s health issue, so quite why the House of Commons titled today’s debate

“support for people experiencing menopausal symptoms”

is a bit of a mystery, particularly when the House of Commons Library report uses the word “women” throughout. Like all mostly women’s health issues, there is often difficulty with our being able to access the right help or support, or even the most basic information. Like many women in Parliament, I am in the age group most likely to be experiencing menopause and, like most women I know of my age, we rely on personal and professional friendship groups for sharing information and our own experiences. We talk to each other and usually find that every one of us will have had some similar, but also some very different, symptoms. It is often hearsay, rumour, second-hand or third-hand stories, shared articles or scraps of advice that are our main source of information about this major life change and huge change to our bodies.

My constituent, Elizabeth Ellis, started her campaign group 50Sense and the campaign “Know Your Menopause” to inform women after she could not get any help and support when she was first going through the menopause herself. How many times do politicians meet people like Elizabeth, who have used their own life experiences to become an expert and a champion in order to help others?

50Sense’s Pausitivity campaign produces a variety of really useful information, as well as posters that people can print out and put up in their workplaces and ask GPs to display. I encourage anyone who wants to know more to find the pausivity.co.uk website and download the great resources, including questions to ask GPs. Of course, that includes men. As husbands, partners, friends, colleagues and responsible employers, they ought to find out as much as they can, too, about this big event in the life of almost every woman they know. I hope hon. Members will note that I left sons out of that list, as, if I am being honest, I know that mine really do not want me to discuss my menopause with them, as lovely as that might sound.

Elizabeth, my constituent, and so many other women like her, should not have had to go back and forth to the GP for almost four years, with symptoms that she now knows were quite obviously the menopause. She was sent to A&E with heart palpitations and was even asked more than once if she was a cocaine user. If she had seen one of the Pausitivity posters she has now produced, it would surely have saved her a huge amount of distress, not to mention the NHS a lot of money. Another constituent, Michelle, had a surgical menopause and, because of the horrendous symptoms and lack of NHS treatment, was forced to go to a private consultant and spend a lot of money because the support she needed was not there. These women are not alone. Menopause cafés such as those mentioned by the Under-Secretary of State for Transport, the hon. Member for Redditch (Rachel Maclean), in the last menopause debate are popular places for women to support each other and share stories. It is extremely common for many women to become almost suicidal with the lack of understanding or help available.

We need to end the postcode lottery or luck element of menopause support. All GP surgeries should have someone available to advise or support women, or should display a poster, so that they know what they are going through is perfectly normal. GPs and healthcare professionals can inform women about local support groups and menopause cafés. We need easy access to fully funded HRT treatment. Men too should also familiarise themselves with some of the facts. After all, most people in the UK are female and at some point will go through the menopause. I urge everyone to log onto pausitivity.co.uk or watch the excellent documentary produced by Davina McCall for Channel 4 recently.

[Ms Nusrat Ghani (in the Chair)]

To ensure that all the speakers get in, we must impose a time limit of four and a half minutes.

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to be called to speak in this important debate and I thank my hon. Friend the Member for Swansea East (Carolyn Harris) for securing it. I know that menopause is shrouded in mystery and certainly used to be a taboo topic, but this is changing and it needs to, as its impact can be complex and numerous as regards health outcomes for women. I will speak on one aspect of menopause—its link with osteoporosis. I do this as co-chair, with Guy Black, Lord Black of Brentwood, of the newly formed all-party parliamentary group on osteoporosis and bone health.

A key factor in women’s health is the protection of bones. Menopause is a crucial time to protect our bone health. When women reach the menopause, oestrogen levels decrease, which causes many to develop the well-known systems of hot flushes and sweats. According to the Royal Osteoporosis Society, a decrease in oestrogen levels also causes a loss of bone density—so the menopause is an important cause of osteoporosis.

Everyone loses bone density and strength as they get older, but women lose it more rapidly in the years following the menopause, losing up to 20% of their bone density during this time. With that loss comes reduced bone strength and a greater risk of breaking bones. According to a survey by the ROS, a fifth of women who have broken a bone break three or more before their osteoporosis is diagnosed. Breaking a bone normally means significant short-term pain and inconvenience, but it does not stop there. Many people with osteoporosis who break a bone live with long-term pain and disability, especially if their back is affected. The reality of broken bones and the fear of falling impacts on everyday activity, stopping people from doing the activities they love. As women lose the protective effect of oestrogen at the menopause, it is a critical time for their bone health and a time to consider many factors, whether that is positive life changes to help maintain bone strength, having a health bone assessment or considering whether osteoporosis drugs are needed to strengthen bones and reduce the risk of fractures. A number of medications are available for those with a significant fracture risk, including hormone replacement therapy, which, crucially, reduces bone loss and the risk of fractures.

It is tragic that the loss of bone strength, and the associated pain and disabilities that fractures cause, is preventable in so many cases, and that is why it is important that around the time of menopause women receive the support needed to consider whether they have a fracture risk that needs treating with osteoporosis medication. To support this, the Royal Osteoporosis Society is calling for GP surgeries to be incentivised routinely to use digital tools to assess risk and prevent fractures, as recommended in the NICE guidelines. Frustratingly, accessible digital solutions already exist and are not integrated properly into IT systems in GP surgeries.

Sadly, many GPs and other healthcare professionals lack the confidence to manage osteoporosis, missing opportunities to identify people at risk early and to prevent that important first fracture. A recent study showed that 75% of older women seen in primary care at high risk of fractures were not given the medication they needed, due partly to a failure to diagnose osteoporosis. These IT solutions can identify people with risk factors for developing osteoporosis before that first fracture. Patients found to be at higher risk can be offered anti-osteoporosis treatment proactively, with a personalised pain management plan comprising medication, lifestyle advice, vitamin D supplementation and fall prevention strategies. That is why it is essential that around the time of menopause, women are properly supported to assess their risk of osteoporosis and fractures. Provided that we support GPs with education and training, including on menopause and bone health, test those at risk and provide preventive medication such as HRT and vitamin D, the vision for early intervention can become a reality.

[Ms Nusrat Ghani (in the Chair)]

I now call Alex Davies- Jones.

Covid-19 Update

Nusrat Ghani Excerpts

Tuesday 2nd February 2021 Commons Chamber

[Matt Hancock]

We are having those conversations all the time. In fact, I spoke to both the Home Secretary and the Transport Secretary about this issue yesterday, ensuring that we have widespread workplace testing available for all civil servants right across the UK.

[Ms Nusrat Ghani (Wealden) (Con)]

I come with good news from Wealden: the vaccination programme is working at a fantastic pace in my care homes and across the constituency. I come also with thanks to my right hon. Friend and to his leadership from lots of people across Wealden. So I thank him very much, but a Minister’s job is never done. Now I am being flooded by messages from parents, grandparents and teachers who want no further delays to school openings, so any assurances would be welcome. Furthermore, as we know that the lockdown has had an impact on our children’s mental health, health and educational attainment, is research being undertaken by the Department so that we can be ready to offer full wrap-around care for our young people when lockdown is over?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before the Secretary of State answers, I should gently remind the House that we still have almost 25 people to go, so brief questions and answers would be appreciated.

Covid-19: Effect on People with Learning Disabilities

Nusrat Ghani Excerpts

Tuesday 15th December 2020 Westminster Hall

[Ms Nusrat Ghani (in the Chair)]

I remind the hon. Members that we have some changes due to covid and that we must observe social distancing rules. Before they exit, Members should wipe down any surfaces that they have spoken into or touched. I will call Members according to the list in front of me.

[Christian Matheson (City of Chester) (Lab)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on people with learning disabilities.

It is a great pleasure to serve under your chairmanship, Ms Ghani. I thank all colleagues and hon. Members for attending this debate.

Health inequality for people with learning disabilities has been evident for decades; even during non-covid times, there were three preventable deaths every day. In 2004, it was reported that 37% of deaths of people with learning disabilities were preventable, and, in 2017, the Equality and Human Rights Commission found that 42% of people with learning disabilities died prematurely.

Despite clear data showing those disproportionate health inequalities, very little has been achieved in tackling the issue in the intervening years. The pandemic has highlighted the issues that many people with learning disabilities face and the lack of understanding in our society of their needs. Things need to change, and quickly; these are deaths that can be prevented and lives that should be lived.

The pandemic has provided a wave of challenges for the NHS and care systems; we do recognise the workers there for their hard work and their sacrifices. However, underlying the struggles faced by the NHS this year are 10 years of austerity and cuts to our public services. It is the most vulnerable who suffer most from these cuts.

In addition to the historic health inequalities, the pandemic has only made things worse and had an even greater, disproportionate impact on people with learning disabilities. They face reduced access to vital care and support, as well as to valued activities and day centres. Increased isolation and loneliness, during the lockdowns, have also had a profound effect on their mental health and will leave lasting effects on their health and wellbeing.

This isolation and loneliness is exacerbated because people with learning disabilities are less likely to have access to technology, which so many people relied on to stay in touch during the pandemic. Professor Jane Seale from the Open University found that, before the pandemic, there was evidence to show that people with learning disabilities already experienced significant digital exclusion, and that this had a devastating impact on their mental health and wellbeing.

A number of my own constituents have been in touch to raise these issues and to tell me how important it is for people with learning disabilities to have some kind of normality—or, at least, access to specialist activities and day centres. One of my constituents was worried that they were not able to take their son to a disabled swimming club—which the son had been attending for years and finds extremely beneficial—because it was across the border, in Wales. Can the Minister clarify that exemptions for cross-border travel exist? Will she make the guidelines easily accessible to ensure that people with learning disabilities are able to access valued activities and care, during the pandemic, without any extra anxiety?

People with learning disabilities have always been more likely to die in hospital, but during the pandemic that percentage has been particularly high. Perhaps one of the main issues that has led to their disproportionate deaths is the lack of awareness and understanding about people with learning disabilities and their needs. The learning disabilities mortality review found that during covid, in 21% of cases that indicated a need for reasonable adjustments—such as the provision of specialist learning disabilities services in hospital, tailored care provisions, or ensuring that the person was supported in an unfamiliar setting by those who knew them—the adjustments were not made.

During the height of the pandemic, specialist learning disabilities support was one of the most requested reasonable adjustments. However, many healthcare staff have been redeployed—working in unfamiliar environments, stressed and exhausted—making it harder to provide the adjustments and specialist care needed for people with learning disabilities. One nurse commented that she was 

“redeployed for four weeks to another ward. During this period there was no specialist learning disability service provided across the Trust.”

Additionally, during the pandemic, a parent or carer simply not being able to accompany a patient with learning disabilities to the hospital can have profound results. Official guidelines stated that non-essential persons were unable to accompany covid-19 patients in ambulances or in hospital, but no definition of “essential” was provided; it was often left as a decision for the healthcare staff. Many people with learning disabilities struggle to communicate—especially in unfamiliar settings—and rely on their carers. Such a lack of communication placed patients at an even higher risk. Will the Minister work with the public health bodies across all the nations to review their guidance to ambulance and hospital services on that important issue? The lack of ability to communicate, and often the lack of specialist training, means that many non-verbal cues such as posture, gestures and general body language are often missed. That has become even more serious during the pandemic as the number of remote consultations and the reliance on the NHS 111 service has increased. NHS 111 is heavily reliant on algorithms, but the specialist care needed for people with learning disabilities cannot simply be picked up by an algorithm. We need an urgent review of the service and whether it is the right way to treat people with learning disabilities.

One of the biggest factors in preventable deaths is diagnostic overshadowing, which is when changes in behaviour are simply attributed to the individual’s learning disability and not investigated further as separate symptoms. My main inspiration for seeking the debate was my constituent Angela, who has led a vocal and active campaign to improve healthcare for people with learning disabilities following her experiences with her son. Parents and carers are crucial to helping to determine if something is wrong with their child. People with learning disabilities do not always demonstrate pain in the same way as other patients, so they cannot always express that something is wrong. Angela’s son was in pain and she knew it, yet healthcare staff refused to listen to her and just attributed her son’s pain to his learning disabilities. It was later revealed that he had a severe case of appendicitis. Their story was later used as a storyline on “Casualty”.

Training specialised nurses for people with learning disabilities is a good step forward, but that must be supported by a widespread understanding of learning disabilities across healthcare staff. The ability of all healthcare staff to provide reasonable adjustments or to be aware of the need just to listen and take parents or carers seriously could be a matter of life and death. Will the Minister therefore commit to providing adequate support to improve the understanding of learning disabilities across all healthcare staff and ensure that all people with learning disabilities are prioritised for face-to-face consultation and care?

People with learning disabilities have faced other huge healthcare challenges. Throughout the pandemic, hundreds of people with learning disabilities have been wrongly—in some cases unlawfully—denied potential life-saving treatment. At the beginning of the first wave of the pandemic, the National Institute for Health and Care Excellence published new guidance on the treatment of patients in critical care, grading them on a clinical frailty scale. The guidelines suggested that those who cannot do everyday tasks such as cooking, handling or making money or performing personal care independently would be considered frail and, as a result, not receive intensive care. All of those tasks are often difficult for people with learning disabilities, but that does not make them frail. I believe the policy was hastily reversed in April, but it has had ongoing damaging consequences, and many individuals with learning difficulties still have do not attempt cardiopulmonary resuscitation orders and do not resuscitate notices on their records without their knowledge. I welcome the Secretary of State’s requesting that the Care Quality Commission looks into inappropriate use of DNACPRs, but will the Minister commit to ensuring that all people with such unjust DNR notices are identified and that those notices are removed from their records to ensure that they can receive intensive care treatment that may save their lives?

Furthermore, in March 2020, the policy of rapid discharge was introduced, leading to thousands of patients being discharged prematurely, discharged without support, discharged to care homes without being tested and discharged into unfamiliar settings with unfamiliar staff who were unable to meet their needs, all of which have a huge impact on people with learning disabilities and are wholly avoidable. I hope we are moving away from that.

Finally, I wish to draw attention to how the pandemic has affected young people with learning disabilities. Statistics show that when it comes to preventable deaths, young people with learning disabilities are worse affected than older people. However, healthcare was not the only factor that greatly affected young people with learning disabilities. Children with learning disabilities or special educational needs faced challenges in education even before the pandemic. Lockdown, the closure of schools and cutbacks to additional support services during lockdown therefore raised new challenges and had specific implications for children with special educational needs, in terms of their learning support, structure, routine and behaviour. Although organisations such as Scope and the National Society for the Prevention of Cruelty to Children have produced resources for parents, achieving a constructive learning environment is likely to have proved extremely challenging in many cases.

Matters were made even more challenging as the supplementary support and activities provided outside school, which promote children’s wellbeing, provide social engagement and routine, and act as an additional resource for parents, were also affected by lockdown. The Petitions Committee highlighted an e-petition that asks for an urgent extension of the statutory age limit for special educational needs provision due to the effects of covid-19. I thank everybody who signed it, and I hope this debate covers their concerns. Young people with learning disabilities often rely on going out in order to learn life skills. They must not be left behind as a result of this pandemic.

Professor Sam Parsons of University College London and Lucinda Platt of the London School of Economics found that the disruption to routine caused by lockdown can be particularly negative for children with special educational needs and can exacerbate behavioural problems. A lack of structure has negative impacts on the social and emotional development of children with learning disabilities and exacerbates mental health problems. Their research also suggests that, given the need for additional educational support, difficulties in catching up are likely to be exacerbated for children with learning difficulties, so ensuring that local authorities have adequate resources to provide services for those children will be even more important in the coming year, following the current disruption to their education and support. What steps will the Minister take to ensure that adequate funding is provided to support children with learning disabilities and special educational needs properly in their education following the school closures during lockdown?

Many of the figures and stories I have mentioned today are shocking, but sadly for many that is the reality and the norm. Some 37% of deaths of people with learning disabilities were preventable. That is simply not acceptable. We must work together to ensure that people with learning disabilities are not an afterthought when it comes to healthcare, education and day-to-day life. More needs to be done to understand their needs properly and give them the support they deserve. The pandemic has shown that the social care system is at breaking point. The Government must provide adequate funding for the care sector and learn from each death of a person with learning disabilities to ensure that those disproportionate and horrific inequalities do not continue.

[Ms Nusrat Ghani (in the Chair)]

I ask the Back Benchers to keep their speeches to about five or six minutes.

--- Later in debate ---

[Dr Mullan]

To continue, I will focus today on the risks that the economic consequences of covid pose to the job opportunities of people with learning disabilities. Locally in Crewe and Nantwich, there are a range of organisations that try to find job opportunities for people. Organisations such as Safe Opportunities and Seetec Pluss, employers such as AO.com and charities such as Community Recycle Cycles have all worked tremendously hard, and secured successful and ongoing employment for people with diagnoses associated with learning disabilities, such as Down’s syndrome and autism.

Those organisations are understandably concerned about the impact the covid-19 pandemic we will have on their ability to carry on delivering this work. We know that even before the pandemic there was a significant gap in the employment of those with learning disabilities. I have heard from residents who have struggled to find work because of their disabilities, and from their families. Recently, I took part in a meeting with Scope that explored this issue and heard from people with lived experience of it.

What might happen now? Employers might rightly be concerned about the health risks their employees could face, given what we discussed earlier regarding the additional risks that we have seen for people with learning disabilities. If we are being realistic, employers who are laying people off and struggling to make ends meet might not go as far as they ordinarily would to try and stretch people’s employability and support people into employment who have disabilities of any kind, including learning disabilities. That is the reality we will face.

Nevertheless, we cannot afford to have a lost generation of young people with learning disabilities who have missed out on employment that they would otherwise have been able to secure. The Disability Confident campaign was launched by the then Prime Minister in 2013, and it aims to encourage businesses to employ disabled people. By December 2019, more than 15,000 employers had signed up to the scheme, as they wanted to offer disabled people roles in their organisations.

There are also local initiatives. As I mentioned, we have an organisation in Crewe and Nantwich called Safe Opportunities. It has launched a campaign called Big10forSEN, which is building towards having 10 big employers locally that are putting in the effort to secure employment for people with learning disabilities.

There are other measures available. There is the 2017 personal support package, which gives people access to a disability employment adviser, and the Access to Work scheme, which provides financial support for the extra costs of being in work that go beyond the reasonable adjustments that are required in law. As part of the Access to Work scheme, specialist support is provided to people with learning disabilities and other less visible disabilities through a hidden impairment specialist team.

In response to the pandemic, the Department for Work and Pensions has worked tremendously hard to develop policy to prevent ill health-related job losses, but we must not forget the Government’s ambition to get 1 million more disabled people into work by 2027. We cannot allow the coronavirus to prevent that from happening.

[Ms Nusrat Ghani (in the Chair)]

There is now a formal time limit of five minutes. I call Ms Olivia Blake.

Covid-19 Update

Nusrat Ghani Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

The truth is that it all depends on how people behave, and it is very important that we all urge people to behave with great care and responsibility over the Christmas period.

[Ms Nusrat Ghani (Wealden) (Con)]

I congratulate my right hon. Friend on the fantastic work he has done on the vaccine, but may I make a plea to him on behalf of my constituents in Wealden whom I spoke to this weekend? They will struggle to get to some of the hospitals which are over an hour away, so will he do all he can to ensure the vaccine comes into my rural constituency?

The other bit of good news is my right hon. Friend saying from the Dispatch Box that the tiers will no longer be at county level. My Wealden residents have gone above and beyond to keep infection rates down; they must not pay the price for what is happening outside of Wealden so can we ensure that their tier remains the same or is reduced?

[Matt Hancock]

I will take a look at the numbers in Wealden in particular. I am concerned about the rate of increase in other parts of the south-east and will have to look very carefully at that case.

On the vaccine roll-out, of course we want the vaccine in all communities across the country. I am delighted that today we managed to start the GP roll-out, which means that we have been able to get vaccine out of the major centres and major hospitals and into over 100 different local communities, and I will check whether Wealden is on the list to make sure everybody in Wealden can get their vaccine at the appropriate time.

Covid-19 Update

Nusrat Ghani Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

We have taken the decision to roll out the vaccine UK-wide at the same pace. I want to get it as soon as possible to the west midlands and to everywhere else, but it is fair to the areas that have had a low, or relatively low, incidence of the disease to make sure that they also have access to the vaccine. Also, the incidence in different parts of the country changes, and the vaccine roll-out programme is very complicated. It does not speed up the delivery of the vaccine in one area to have slowed it down in another. That is why we have taken a UK-wide approach.

[Ms Nusrat Ghani (Wealden) (Con)]

In keeping with my right hon. Friend’s spirit of working together, I stand not only to represent Wealden, but to speak on behalf of my hon. Friends the Members for Bexhill and Battle (Huw Merriman), for Eastbourne (Caroline Ansell) and for Hastings and Rye (Sally-Ann Hart). We wish to collectively thank the CEOs of the clinical commissioning group and East Sussex Healthcare NHS Trust, our county leader, Keith Glazier, and our local department for public health for working with us day in, day out to understand the data and the reason for the infection rates.

We are deeply disappointed that, considering all the five indicators, where we mark extremely low, we are in tier 2, and we are disappointed that central Government have not consulted local leaders, because they would then have been able to investigate the data and, hopefully, show us how we can move into tier 1 from tier 2. Will my right hon. Friend provide some assurances that these conversations will take place with local leaders and confirm that transparent objective criteria will be published for each tier, and how we can slide between each tier?

[Matt Hancock]

Yes, absolutely—I can give both those assurances. Across Sussex, case rates are at 120. They do need to come down. Like my hon. Friend, I would like to see Sussex get to tier 1 as soon as possible, and we will keep talking to the local area. As I said earlier, all directors of public health have been invited to discussions and consultations with the public health team. That feedback fed into these decisions, but we have to make sure that those conversations continue. The key message to everybody across Sussex and in the Weald, in particular, is that if we all stick together and follow the rules, we know that we can get this virus under control, and that will then lead directly to the lifting of restrictions, which we will regularly review.

Covid-19 Update

Nusrat Ghani Excerpts

Programme motion
Monday 19th October 2020 Commons Chamber

[Matt Hancock]

The proportion of contacts that are reached that are in what are called complex settings in the system—for instance, in care homes it is relatively easy to find all the contacts by the nature of the setting—has itself fallen, as the number of cases has risen. If we look at the effectiveness of the system as a whole, both national and local, at reaching people in the community, we see that it has been broadly flat, as has the proportion reached in those complex settings where it is much easier and often the proportion is close to 100%. The challenge has been that as the number of contacts in the community has risen, so the overall proportion of those who are harder by their nature for the contact tracing system to reach has gone up. That is the direct explanation for the figures that the hon. Lady describes. The best solution to that problem is the combination of the national and local systems working together, and we are putting in place closer connection and extra financial support, both in Liverpool and Knowsley, as she sets out.

[Ms Nusrat Ghani (Wealden) (Con)]

I commend my right hon. Friend for overseeing 300,000 tests a day across the country. Will the Minister thank care workers who do such tremendous work in care homes in Wealden? He will know our concerns about winter flu coming to care homes as well. I had a long meeting with care home providers across the constituency and they are incredibly pleased with the access to testing, but one care home in Uckfield complained that 25% of tests were not picked up by a courier—I know that my right hon. Friend will want to nip that in the bud immediately.

[Matt Hancock]

Throughout this, and even with the challenges with demand for testing that we saw last month, we kept the tests going to care homes because people who live in care homes are the most vulnerable. No matter what we do to protect care homes from coronavirus, the higher the number of cases in the community, with staff living in the community and, of course, people visiting where visits are allowed, there is more likelihood of a case getting into a care home. It is a sad fact of life. We do everything we possibly can to prevent that, as do the brilliant care staff who work in her constituency, to whom I pay tribute. On the particular point about a courier being late for a pick-up, I will look into that immediately and see if we can resolve that.

Public Health: Coronavirus Regulations

Nusrat Ghani Excerpts

Tuesday 13th October 2020 Commons Chamber

[Ms Nusrat Ghani (Wealden) (Con)]

I am pleased to contribute to the debate. Many of us on the Back Benches fought for this opportunity to contribute, although I was hoping that we would have longer than three minutes. I do not doubt that Ministers are grappling with the most difficult trade-offs in managing the spread of the virus. In particular, I know that the Minister for Health bears a huge responsibility in trying to ensure the lowest possible number of covid fatalities.

I support the Government in their efforts to manage the virus and their three-tier system, but I have concerns similar to those of my hon. Friend the Member for South Thanet (Craig Mackinlay), and I want to raise three of them. First, the Prime Minister was brutally honest yesterday in telling my hon. Friend the Member for Wycombe (Mr Baker) that a vaccine may or may not be available, depending on what science delivers. If that is the case, we need a long-term covid strategy that does not involve areas being put in and out of restrictive measure for many years to come, which will not only damage local economies but have a tragic impact on the diagnosis and treatment of other potentially fatal health conditions among my constituents in Wealden.

In particular, cancer comes to mind. The national health service has been called the national covid service by many of my constituents. I received an email from a local resident, Mike, who is trying to get a neurosurgery consultation appointment. He has been told that, for his condition, he has to wait 48 weeks, not the 26 weeks that it would have been in February. Amusingly—even though my residents in Wealden are struggling, they still have a sense of humour—he says that patients are asked to use their “fastest finger first” when ringing to try to get a same-day hospital appointment:

“Anyone without a swish redialling telephone and the persistence of Miss Marple has little chance of getting an appointment.”

That is the problem we face. Our efforts to protect the NHS and protect our constituents from getting covid are unfortunately leading to people being unable to manage their other health conditions.

Secondly, testing and tracing continues to be an issue in my care homes and schools, and I urge the Minister to do what he can to ensure that the turnaround time for tests is much swifter than it is at the moment. The final point I wish to raise is about hospitality. It is clear that there is no scientific basis for the 10 pm curfew. The SAGE scientists say:

“Curfews likely to have a marginal impact. Low confidence.”

We are repeatedly told that this virus spreads indoors. A story in today’s Telegraph says that spending on alcohol is £261 million more than it was in September. That is no doubt because people are spending money on booze to drink at home, where the virus spreads much more. We need to be clear about the unintended consequences of the decisions we take.