Mental Health

Rehman Chishti Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Moon]

I thank the hon. Gentleman for his intervention. When he was on the Defence Committee, he took a particular interest in this area. As I will explain later, reservists are particularly vulnerable. That is more of a problem in the US because they are deployed for longer and have less support once they are home. However, it is a major issue that we must address in the UK as we increase the percentage of reservists in our armed forces.

The work at King’s college London highlights the importance of adhering to the Harmony guidelines and the negative impact of changing tour lengths during tours. The Secretary of State for Defence announced in a statement yesterday that we are extending the tour length for two brigades that will be deployed over the next two years. That has implications and we must ensure that King’s college London is involved in tracking the changes that it brings.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the hon. Lady give way?

[Mrs Moon]

I will, but this is the last intervention that I will take.

[Rehman Chishti]

The hon. Lady is talking about the research undertaken by King’s college London. Experts at Imperial college London have said to me:

“Mental Health Services and research are a UK success story. We have produced world leading research in many areas which has led to new treatment approaches which have improved patients’ lives”.

Will she join me in paying tribute to all the researchers and academics in our country who have done so much to improve the quality of care for patients?

[Mrs Moon]

The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.

The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.

Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.

I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.

I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.

US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.

Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.

There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.

Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.

Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.

Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.

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[Mr Walker]

The hon. Lady makes a fabulous point. Many organisations are doing that at the moment. The Work Foundation launched a report in the House of Commons a couple of months ago, and I was delighted to be able to speak at that event. Some people who had been excluded from the labour market for many years but are now in work spoke at the launch downstairs in the Churchill room. It was moving and uplifting. Good news stories tend to be uplifting and we need to have more of them. There is still a lot of disappointment and sadness in this area, and that is why we have such an obligation in this place to work with all Governments to improve outcomes and ensure we get things right.

[Rehman Chishti]

Like every other hon. Member here, I pay tribute to my hon. Friend for the work he has done on this issue over many years. Does he agree that the current NHS approaches are too focused on fighting fires, and that more investment in community and preventive care would improve quality and potentially reduce costs, a view shared by an expert from Imperial college?

[Mr Walker]

I agree with my hon. Friend. We need to ensure that the systems are in place in local communities to provide people with the support they require. Care in the community is a great concept if that care exists. It exists more in some places than in others.

I will not read out all the names on my list, but they show that civil society is alive and well. They are not statutory organisations; they are founded and run by people who wanted to reach out and do something about a problem that was relevant and prevalent in their community. I am full of admiration for them.

Health Inequalities

Rehman Chishti Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is my great honour, Dr McCrea, to serve under your chairmanship.

It is crucial that everyone in this country, regardless of income or location, should have access to the same level of health care; social background should not be a determinant of health. Currently, people who live in the poorest neighbourhoods will die on average seven years earlier than those in the richest neighbourhoods, and the average difference in disability-free life expectancy is 17 years between the richest and the poorest. We should be concerned about health inequalities existing on that basis, because it shows not only that we are not all in this together but that people throughout the country are unnecessarily and unfairly suffering because of their social background.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate the hon. Gentleman on securing the debate and on the work that he has done on the subject over the years. He was talking about life expectancy; in Medway, which covers three parliamentary constituencies, the difference in life expectancy between the most deprived 10% and the least deprived 10% is 9.6 years. He talked about all being in this together, but that 9.6 years did not arise in the past three years; that difference in life expectancy was present for many years under previous Governments as well.

[Mr Sharma]

I thank the hon. Gentleman for his important intervention, but we are not present as part of the blame culture. We are not debating what happened 10 years ago; we are talking about learning from the past and about how best to improve services. I am sure that the Minister will answer such questions, but I assure Members that I am not here to defend or not to defend, but to raise the issue, and to talk about what is happening in today’s terms and about why, what and how to improve.

The previous Labour Government committed themselves to reducing health inequalities. They made progress in meeting targets on infant mortality and headline indicators for life expectancy as a result of early intervention programmes and initiatives such as Sure Start. Reducing health inequalities is not only fair but makes economic sense.

--- Later in debate ---

[Anna Soubry]

I am very grateful for that intervention. My hon. Friend makes the point more ably than I can that much of the great work to reduce health inequalities is not about whether there is an urgent care centre or an accident and emergency centre within 500 yards or 5 miles of where someone lives. Work on public health is critical, and that is why I am so proud that this Government have increased the amount of money available to local authorities, which now have responsibility for delivering public health. They had that historically and we have returned that power to local level. That is important in the delivery of improvements in public health. This Government’s view is that local authorities, as in the hon. Gentleman’s constituency, know their communities better than Whitehall does. In the delivery of key and important work on public health, it is right and proper that local authorities have that responsibility. They, too, have a statutory duty to deliver on health inequalities. That runs through all their work of looking after the public’s health, but, most importantly, addresses those very factors that cause the sort health inequalities of which we are all conscious. For example, there is a clear demographic link between smoking and diabetes.

If the hon. Gentleman goes to Leicester, he will see the work that is being done there and in Leicestershire with the clinical commissioning groups—the GPs are now doing the commissioning—working for the first time with the local hospital and looking at a whole new way of delivering a better pathway not just of care, but of early diagnosis and prevention, linking those up in a way that has never been done before in the NHS. If he sees those examples, far from criticising the Government or having doubt about our commitment to health inequalities, he will take the opposite view.

If the hon. Gentleman needed yet further proof of the great work that can be done under the new way of delivering public health and commissioning in the NHS, he could do no better than take a trip to Rotherham in Yorkshire. I went there to see its fantastic work in tackling obesity. Obesity is a clear issue of health inequality and Rotherham has taken a totally joined-up approach. GPs are working with dieticians, schools and planners, with the local authority at the heart. They are all coming together to deliver a considerably better strategy, with real results in tackling the problems in that area.

On funding, it is important for the hon. Gentleman to understand that we have increased the amount of money that is available. It is now ring-fenced, on a two- year deal, so that real security and certainty is given to those local authorities. In some areas, we have increased up to 10% the money that is available to spend on public health.

[Rehman Chishti]

I completely share the Minister’s opinion about an approach where local authorities know what is in their best interests—for example, in relation to obesity in Medway, which has one of the highest recordings above the national average for obesity. However, I want to raise another point with the Minister. On diabetes and organ transplants, certain parts of the community—or certain parts of minority communities—are more likely to be affected. Will there be a national strategy that covers and supplements what is going on locally, because these are national issues that affect minority communities throughout the country?

[Anna Soubry]

I am grateful to my hon. Friend for making that point. The subject of diabetes—type 2 in particular—and the clear link to obesity and being overweight is something about which I am beginning to have a passion, because I can see the great work that can be done. We have just done a cardiovascular strategy. It is a call for action about mortality, and we know that cardiovascular disease work sits within that, and that cardiovascular work—I am getting very worried, Dr McCrea, because I am beginning to sound almost as though I am a health professional, when I am nothing more than a simple hack criminal barrister, rather like my hon. Friend.

The point, however, is that we know that if we look at diabetes, many other boxes are ticked in improving the lot and the health of our population. Certain parts of our population, in particular, have suffered from health inequalities, and my hon. Friend makes a very good point about some of our communities—in the Asian community, there is a great prevalence of type 2 diabetes, as there is in the Afro-Caribbean population. If we look at diabetes prevention, earlier treatment and diagnosis, and then proper treatment and good outcomes, other boxes are ticked—for example, obesity and being overweight, and all the other things that often flow from diabetes, such as the link with cardiovascular disease and so on. My hon. Friend makes a very good point about how a local authority beginning really to drill in and target a particular illness or disease can have many beneficial spin-offs in the manner that I have described.

The Government have established a comprehensive measurement system designed to measure not only overall improvement, but, in particular, inequalities. The NHS outcomes framework—I know that these words do not trip off the tongue and that they may be lost on the majority of completely normal people, but they are important documents—forms the basis for measuring progress on delivering improved results for patients and reducing health inequalities. The NHS England business plan commits to assessing health inequalities across a range of dimensions in the NHS outcomes framework, and those important documents guide our clinicians, the commissioners, and everybody involved in ensuring that we live longer, healthier, and happier lives. That exercise may reveal important health inequalities that have not previously been evident. The public health outcomes framework includes an overarching aim to reduce differences in life expectancy and healthy life expectancy between communities, through greater improvements in more disadvantaged communities. Public Health England will regularly publish data for the indicators, including breakdowns by key equality and inequality characteristics to enable monitoring to help focus action where it is needed.

I am looking forward to the time when we begin to publish, by local authority, the outcomes in each local authority on such things as the stopping of smoking, and the work that is done on the abuse of alcohol. Invariably, we gather that information, but when we start to publish it and put it in the public domain, Members of Parliament, local councillors and members of the public will all have access to it, and they will be able to see how their local authority is performing. We will not try and trick anybody and we will not be unfair, but we will ask people to compare like with like. We make it clear to local authorities that they do not all start from a level playing field, because many of them, unfortunately, are inheriting public health policies that were not some of the best. Therefore, we will recognise that—it is one of the legacies left over from the previous Administration. However, because people, GPs, and everybody involved in the delivery of health, including councillors and Members of Parliament, will have public access to such information, I have no doubt that that will begin to drive a real desire to reduce health inequalities.

I mean no disrespect to the hon. Member for Ealing, Southall, but I know the previous job of my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and he, like me, knows that there is no better grit in the millstone among professionals than when comparisons are made about who has a better set of results. There is always good, healthy competition between professionals. We have seen that in the past when we published—I am not going to try to pretend that I can remember what it is, and if I say what I think it is, Dr McCrea, you can bet your bottom dollar that it will be wrong, but I know that in the past we have published the outcomes of particular procedures and surgery, and that it has improved the outcomes to everybody’s benefit when there has been a bit of healthy competition between professionals. That is what we intend to do by publishing the statistics on public health outcomes by local authorities, so that everybody can see what is out there. We saw it in recycling rates. Publishing information did exactly what we hope it would—it upped everybody’s game, and that is one of the reasons why we will do it.

To conclude, we have created a new health system that makes tackling health inequalities core business, underpinned by new legal duties, measurement and assessment. The local autonomy that we have given to our CCGs and our health and wellbeing boards will enable them to take focused action that meets the needs and aspirations of their populations, concentrating on the groups that experience the worst health inequalities. I hope that the hon. Member for Ealing, Southall is now in no doubt about what has been done.

Tackling health inequalities is a key priority for the Government, and it supports the wider focus on fairness and social justice. I know from a radio interview that I gave on Friday—on the “Today” programme on the BBC—that Professor Marmot, who wrote his brilliant report on health inequalities, has already recognised how important it has been that we have made this a statutory duty. He has praised much of the work that this Government have done—I have to say, in stark contrast to the previous Government, of which the hon. Gentleman has been a firm supporter.

Our approach is to design a system that empowers those at a local level to take action on inequalities, with a strong focus on commissioning quality services and on improving the health of the poorest, fastest.

Question put and agreed to.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

[Rehman Chishti (Gillingham and Rainham) (Con)]

2. What support his Department has given to local authorities in respect of their new public health responsibilities.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Department has continued to work with all its partners to ensure that there is a swift and effective transition of public health responsibilities to where they should be—back with local authorities. We have made available £15 million to ensure that the transition is successful and complies with all the requirements that we have laid down.

[Rehman Chishti]

I thank the Minister for that answer. I invited the Silver Star charity to my constituency on Friday, where it offered free diabetes tests to all residents. Will local authorities be encouraged to work with such charities to improve public health?

[Anna Soubry]

The Silver Star bus is making many journeys because as well as going to my hon. Friend’s constituency, it is coming to mine on Saturday. It is an outstanding charity that provides diagnosis at a local level. I pay tribute in particular to the right hon. Member for Leicester East (Keith Vaz) because the charity goes to communities that are often hard to reach, such as the Asian community, where we need to do good work to reduce the level of diabetes, both type 1 and type 2. I look forward to local authorities working with outstanding charities such as Silver Star.

Suicide Prevention

Rehman Chishti Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr McCrea]

Once again, I hope to touch on that point. I believe that that link needs to be considered. Certainly, for many people who were involved in such activities—perhaps they were drawn into them and now, unfortunately, must live with the consequences for the rest of their lives—guilt can be a leading factor pushing them towards suicide.

The Bamford review on mental health promotion, published in Northern Ireland in May 2006, reinforced the need to prevent suicide. It found that in the 25 years from 1969 to 1994, more people died by suicide than as a result of the troubles in our Province.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate the hon. Gentleman and his party on bringing this important debate to the Floor of the House. He talks about the factors linked to suicide. Will he accept that mental health issues are another key factor linked to suicide and that MPs and others need to remove the stigma attached to mental illness so that people feel able to ask for the help they badly need?

[Dr McCrea]

I agree wholeheartedly with those remarks. The Bamford report highlighted the link with mental health. I agree that we must remove the stigma attached to mental health, as well as the stigma attached to suicide, because many families are deeply hurt by it.

--- Later in debate ---

[Dr McCrea]

I agree wholeheartedly with the right hon. Gentleman’s comments. I have found a lack of knowledge in the community about the help available through such agencies.

We community leaders must be willing to say, “This is not a taboo subject. We can talk about this.” The country must be willing to open up. We tell young people to open up when they have a problem or feel isolated, but we legislators must be willing to do the same, and not run away from the issue, treating it as something to be hidden or pushed aside.

I am delighted that my right hon. and hon. Friends have brought this debate before the House today—I know that I have support on this issue from across the political spectrum in Northern Ireland—but I really feel that this is a problem right across the United Kingdom. As I pointed out at the beginning, in one year, 1 million people across the world reached the point where they took their own lives. That is very serious and we are not immune to it—not one part or region of the United Kingdom is immune and I can assure hon. Members that not one family is immune either. This issue can touch every family, no matter how rich or how poor. Every family can experience the very same pain and hurt that has been expressed to me. That is why we have secured this debate.

The report also found that, on average, deaths due to suicide since 2000 have exceeded deaths on the roads and concluded that suicidal behaviour places a heavy human and financial burden on society in Northern Ireland, with an annual cost to the economy of £170 million owing to work days lost and hospital admissions for attempted suicides and suicidal behaviour. Research undertaken by Mike Tomlinson of Queen’s university in 2007 found that the Northern Ireland suicide rate had grown since the mid-1990s, which was attributed to younger people, particularly men, taking their own lives.

[Rehman Chishti]

The hon. Gentleman talks about young people. Does he know whether there have been any discussions between the devolved nations about preventing young people from accessing suicide websites? Such prevention work is crucial.

[Dr McCrea]

Once again, I am deeply appreciative of the hon. Gentleman’s intervention and I wholeheartedly agree with him. We will endeavour to take up that point as the debate continues.

Tomlinson found that about 150 suicides were recorded annually between 2000 and 2004, but by 2006 that figure rose to 291. He argued that the end of the conflict in Northern Ireland might have brought its own problems. Figures released by the Office for National Statistics show that in 2011 there were 6,045 suicides among people aged 15 and over in the United Kingdom—an increase of 437 compared with 2010. The UK suicide rate increased significantly between 2010 and 2011, from 11.1 to 11.8 deaths per 100,000 of the population. That trend was further reflected in Wales, which recorded 341 suicides—its highest rate since 2004. Scotland also saw an increase, from 781 deaths by suicide in 2010 to 889 in 2011.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Speaker]

I must say to the House that if we are to get through the questions we need shorter questions and shorter answers from now on.

[Rehman Chishti (Gillingham and Rainham) (Con)]

4. What steps he is taking to support the recruitment and training of midwives.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The Government are committed to ensuring that the number of midwives in training matches the needs of the birth rate. There are now over 800 more midwives working in the NHS than there were in May 2010, and a record 5,000 currently in training.

[Rehman Chishti]

The Oliver Fisher neonatal intensive care unit at Medway Maritime hospital in my constituency is an excellent charity that looks after approximately 900 premature and sick new-borns each year. What further midwife support will the Government give to such care units?

Diabetes

Rehman Chishti Excerpts

Wednesday 9th January 2013 Westminster Hall

[Mr Sanders]

That would certainly be extremely helpful and would complement the atlas of care by, in a sense, putting the actuality into the story behind the figures. It is extremely unhelpful not to be able to drill down to what is really happening on the ground; we could do that if such statistics were available.

Some of the problems of disseminating information have been offset by the work of NHS Diabetes. It has been instrumental, first, in monitoring variations in care and driving the collection of more robust data, which has culminated in an extremely important publication, the national atlas of variation; and, secondly, in working tirelessly to rectify the problems it uncovers, linking national policy intention with policy implementation on the ground, including support targeted on where the greatest improvements are necessary. It is important that that work continues, as much more could be done. I hope that the Minister will reassure me that, despite the upheavals in the commissioning architecture, NHS Diabetes will retain its central role.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I, too, pay tribute to the hon. Gentleman for his fantastic work as chairman of the all-party group on diabetes. Does he agree that there need to be performance targets, like those for cancer, stroke and heart disease? At the moment, there are not the mandatory performance targets for diabetes that there are for those other diseases.

[Mr Sanders]

I am grateful to the hon. Gentleman for making that point. When one puts together speeches, they sometimes go on too long, and I had cut out that bit, so I am glad that he has raised it. The big issue is that the cause of death is sometimes recorded as stroke or heart disease when the underlying problem is diabetes. We have targets for cancer, heart disease and stroke. We really ought to look at diabetes as the root cause of other conditions for which there are targets.

The variation in care across the country is probably the largest worry for patients now, and the new implementation plan should focus on that. Failings in diabetes care cause an estimated 24,000 premature deaths each year. In 2001, the Department of Health published the national service framework for diabetes, which set out clear minimum standards for good diabetes care. Those standards include nine basic care processes that aim to end preventable complications by looking for early warning signs. Despite those targets, much of the country has seen little progress towards improving detection of type 2 diabetes and reducing the number of preventable diabetes complications. In 2009-10, results from the national diabetes audit showed wild variations in inputs and outcomes for both type 1 and type 2, including the astounding figure that the proportion of type 1s receiving the recommended nine care processes ranged from as low as 5% to 50%, with an average of 32% in England. The figures were only marginally better for type 2s. It really is not good enough.

The point about the condition is that people treat themselves 364 days a year and see a practice nurse or sometimes a general practitioner—more rarely, these days, a consultant—only once a year, although they should receive the nine care processes. The chance of developing diabetic complications can be reduced by keeping blood pressure, blood glucose levels and cholesterol levels low. Regular monitoring, backed up by periodic checks, is the key. The results from the national diabetes audit demonstrate that more needs to be done to end the postcode lottery of care for people with the condition. When as few as 5% of people with type 1 diabetes are receiving all nine care processes in some areas, there is a definite failure of care. If all health care trusts followed the national service framework, such complications as blindness and kidney disease—as well as stroke, heart and other diseases—could be prevented.

I hope that we will explore a range of best practices, but I want to highlight a couple that have scope to bring immediate improvement at very little cost. An acute issue is the provision of insulin pumps for type 1s. That is an example of where the UK should look abroad for best practice. Type 1s in other developed countries, such as France, Germany or the US, can expect to benefit from a pump if that is required for their diabetes management. Somewhere between 15% and 35% of type 1s in those countries have pumps, which enables them to lead normal lives, but in the UK the figure is less than 4%. That is clearly a failure of the commissioning structure as it is now. Will the Minister address how that is likely to improve? The Work Foundation has estimated that, if pump usage reached 12%, the NHS would save about £60 million a year.

Another example of where best practice is needed is surprisingly simple: good local leadership. Good leadership, as I have been fortunate enough to experience in my own area of Torbay, is essential to promoting effective and integrated services. Integration is key to reducing costs in the long term and, more importantly, to improving patient outcomes, which all too often get lost in the debate over health care services.

The move to clinical commissioning groups, with the potential for better scrutiny and criticism from patient groups, local authorities and health care staff could, in theory, lead something of a revolution in spurring innovation and creativity and in the striving to find best practice.

Just as educating the commissioners is crucial, so, for diabetes, is patient education, which has the happy side effect of making patients far more aware of whether they are receiving a good service and enabling them to become better advocates for their condition. I have no doubt that the great knowledge possessed by volunteers for Diabetes UK, the Juvenile Diabetes Research Foundation, INPUT and the many other groups involved in diabetes will be a considerable asset in shaping good services at a local level now that we have better scope for patient scrutiny and involvement.

In the wider sense, patient education is the core to preventing complications, which diminish the quality of life for patients and which, all too often, reduce life expectancy and increase the costs to the NHS in the long term. Good patient education programmes may require some investment, but they would pay for themselves many times over.

On a broader level, work needs to be done on detection and prevention. The number of people suffering from type 2 diabetes is set to reach a staggering 5 million by 2025. However, what many people do not know is that type 2 diabetes is a largely preventable disease. At the very least, its onset can be delayed and complications reduced.

NHS checks are vital to the detection and prevention of diabetes. In theory, such checks are available to all 40 to 74-year-olds who are seen to be at risk of developing diabetes. Shockingly, a number of primary care trusts in the UK failed to offer a single person an NHS health check last year, which demonstrates the dangerous variations in provision in the NHS. The Government can look to rectify that if they create a new national implementation plan for diabetes. Indeed they may even take up the suggestion by the hon. Member for Gillingham and Rainham (Rehman Chishti) to set targets for diabetes.

This year, the current national framework for diabetes comes to an end. It is important that we build on the successes of the framework, that we focus on reducing discrepancies in diabetes care and that the new framework emphasises the importance of health checks and prevention of the disease through simple means such as diet management. Indeed, it is essential for the Government to spell out to commissioners and to patients what services can be expected and to provide a road map to show where we want to be in a few years’ time and how to get there.

[Mr Sanders]

It is a combination of both. We cannot prescribe from the centre precisely what must happen in every area. Of course local areas must reflect their own demographics and their own health picture and be able to apply priorities accordingly. However, there is something to be said for ensuring that local areas have the tools that they need, which is where NHS Diabetes did such a good job on the back of the NHS framework for diabetes.

It is equally important that health checks are used to detect diabetes in its earliest stages, as early detection and appropriate treatment can prevent the severity of the condition and the risks associated with complications such as amputations.

[Rehman Chishti]

On health checks, the hon. Gentleman must have seen the report that says that, according to Diabetes UK, nine out of 10 people do not know the four main symptoms of type 1 diabetes. Surely, therefore, the education should look at ways in which people can identify for themselves the symptoms that can lead to type 1 diabetes.

[Mr Sanders]

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other— I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

--- Later in debate ---

[Jim Shannon]

Yes, I agree. When people make interventions, I always wonder whether they have read my script—preventive medication is the very next issue on it.

In my doctors surgery in Kircubbin and, indeed, across Northern Ireland preventive measures are in place. There are diabetic surgeries, and the matter is taken seriously. The UK strategy that we have had for the whole of the United Kingdom of Great Britain and Northern Ireland and that will come to a conclusion this calendar year has made significant progress towards reducing the potential numbers, but diabetes has increased over the same period. There are some 100 diabetics in my doctors surgery in Kircubbin.

[Rehman Chishti]

The hon. Gentleman talks about the United Kingdom strategy. Does he accept that certain people from different ethnic backgrounds are more likely to get diabetes? For example, according to the Wellcome Trust, 50% of people from south Asian and Afro-Caribbean backgrounds would have diabetes by the age of 80. Any UK strategy would therefore have to take ethnic composition into account, because such people are affected differently.

[Jim Shannon]

That is an excellent point, and I am sure that the Minister will address it in her response. There are groups in the whole of the United Kingdom in which diabetes is more prevalent, and we need to look at those target areas.

There are 3.7 million people in the UK diagnosed with type 2 diabetes. I was diagnosed four years ago. With me, it was down to bad eating habits, stress and the fact that there were no set hours to my job. I ate whatever was quickest, and that was Chinese, usually with two bottles of coke, five nights a week. That was why I was 17 stone. I am now down to 14 and a half stone because I no longer do that. The issue is eating and living styles—eating what is quickest rather than what is best.

Edwin Poots, the Minister at the Department of Health, Social Services and Public Safety in Northern Ireland, is very aware of the ticking time bomb that is diabetes. I am aware of the key initiatives in operation in Northern Ireland, and I know that the Minister here today has had discussions with the Minister in Northern Ireland. They are doing a great job, including setting aside funding to employ additional diabetic staff—specialists, nurses, dieticians and podiatrists. That is providing all the help that a diabetic needs, but it is still not enough.

We need a concerted effort across the United Kingdom, through the media, and even perhaps through the TV soaps. I am not a soap watcher. I could not tell anyone what happens in “Emmerdale” or “Coronation Street”, but my wife could. She knows everyone in them—what they are doing this week and what will happen to them next week. Could we not perhaps use the soaps to make people more aware of the issue? I understand that plenty of issues are brought up in them regularly, so perhaps we should try this one.

It is great that our children are taught about diabetes in school. It is surprising what a five or 10-year-old knows about food that their mum and dad do not. Who is educating the mums and dads at home who are making the dinner and buying the shopping? The hon. Member for Blaenau Gwent (Nick Smith) made a point about how the food coming into the house is controlled by the parents. Diabetes UK Northern Ireland is taking part in an organisation-wide campaign entitled “Putting Feet First” to raise awareness of amputations among people living with diabetes and to work to prevent unnecessary amputations.

The Minister might want to comment on the new medications that are available. In the press this week, there was talk about a new diabetic medication in tablet form that could replace—not totally but partially—type 1 injections. The figure used was a cost of £35 per month. It would be good if we could get some feedback about whether the new medications will be available across the United Kingdom and whether everyone will be able to take advantage of them.

In Northern Ireland last year, 199 diabetes-related amputations took place, and the “Putting Feet First” campaign highlights that an estimated 80% of lower- limb amputations are preventable. There must be a UK strategy to reduce diabetes-related amputations by 50% over the next five years. What can we put in place in this Chamber to highlight and support the campaign? How can we use our influence to see the number of cases of type 2 diabetes dropping, instead of this steady rise?

The links between type 2 diabetes and obesity are firmly established, and it is clear that, without appropriate intervention, obesity can develop into diabetes over a relatively short time. For instance, the risk of developing type 2 diabetes is about 20 times more likely in obese, compared to lean, people. A newspaper recently stated that academic sources have estimated that the predicted rise in obesity rates over the next 20 years will result in more than 1 million extra cases of type 2 diabetes, and that is really worrying. Can that go unchallenged, when it is within our power, as parliamentarians, to do something about it, at least by putting a strategy in place or by beefing up the ones that we already have? When the current UK-wide strategy ends, it will perhaps be time to do something more.

I live the life, as do many others, of testing my blood every day, of feeling unwell when my blood sugar is out of control and of worrying that the next visit to the doctor will bring worse news, which can be the case if we do not discipline ourselves and ensure that we do things right. That is not the life that I want to have, or the life that I want my family, friends or constituents to have. The way to take on the issue is to continue with the UK-wide strategy, with dedicated funding and with all the regions working together, which will save money in the long run and, more importantly, improve the quality of lives across the United Kingdom.

I urge the Minister to take the initiative. I believe that she will and that her response will be very positive, because she understands the issues. I urge her to work with the devolved bodies, in coming together to disarm the ticking time bomb of diabetes—the cost of which some people indicate will be £10 billion—before it explodes. Type 2 diabetes is preventable, and we must do all that we can to prevent it. Education, with attention paid by everyone in this Parliament and the regional assemblies, is the way to do that.

Winterbourne View

Rehman Chishti Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank the hon. Lady for that question. What was striking when I visited Tower Hamlets this morning and talked to the leaders on the health and local authority sides was that, despite being the third most deprived borough in the country, Tower Hamlets is one of the lower spenders on institutional care because it is doing things the right way. Tower Hamlets has not referred a single person from the borough to an assessment and treatment centre for three whole years. Tower Hamlets has demonstrated not only that that is possible, but that it often ends up costing much less to provide the right care in the community—[Interruption.] Well, that is what the borough leaders find. That is what I have been told by them and by many other people in the sector. An individual should have the care that they need, and if the cost of that package in the community is substantial, it should be met. We should never compromise on that. All I am saying is that the overall cost of providing the right kind of care in the community often looks lower, when compared with those institutions in which the cost is extraordinarily high—as much as £3,500 per week per patient.

[Rehman Chishti (Gillingham and Rainham) (Con)]

The Minister mentioned unannounced inspections. Will they involve speaking at random to patients at the centres? Linked to that point, some hospitals around the country have a whistleblower policy that allows people who work in them and others to take their concerns to senior officials in confidence.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 27th November 2012 Commons Chamber

[Norman Lamb]

That is absolutely a priority for the Government and the right hon. Lady is right to highlight its importance. The NHS Commissioning Board will work with local clinical commissioning groups to ensure that we raise the standards of health and care services, but she is absolutely right to highlight the importance of substantially improving access to dementia services.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Can the Minister clarify how often mental health centres and hospitals are inspected and how often patients are spoken to to help improve the service?

[Norman Lamb]

The Care Quality Commission inspects all services. Of course, there is now a registration system for such services. The hon. Gentleman is absolutely right to highlight the importance of ensuring that mental health services are regarded as just as important as physical health services, which has not always been the case.

Winterbourne View

Rehman Chishti Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

The role of whistleblowers is central. Importantly, the Government have funded a whistleblowing helpline, which is available to any worker in the care sector—it covers all care homes. It is important that any worker at any stage feels they can raise their concerns with the relevant authorities so that they are properly investigated. What happened with the whistleblower at Winterbourne View was not acceptable, because their concerns were not taken up effectively.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I welcome the Minister’s statement. On inspection, can he clarify what provision exists for inspectors to speak to patients? How will that be further enhanced?

[Norman Lamb]

I am sure that inspectors can speak to patients, and that they routinely do so, but I will check on the important point the hon. Gentleman makes. We mentioned earlier the views of those with learning disabilities and their families, but it is essential that the regulator hears directly from them of their potential concerns.

Mental Health Act 1983

Rehman Chishti Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

I shall certainly pass my hon. Friend’s question on to Dr Harris. It is not clear that the irregularity is a result of reorganisations, but I want to give Dr Harris a completely free hand. We shall then listen to what he says very carefully.

[Rehman Chishti (Gillingham and Rainham) (Con)]

rose—

[Mr Speaker]

Ah! A late arrival at the station.

[Rehman Chishti]

I am so sorry, Mr. Speaker.

I am very grateful to the Secretary of State for his statement. Despite the irregularity, sections 2 and 3 of the Mental Health Act give patients an automatic right to a tribunal hearing, and the tribunal will have been able to consider their applications for release.

[Mr Hunt]

That is correct. Nothing in the legislation will affect any rights that patients have, except with respect to the technical irregularity involving the authorisation of doctors under section 12.