World Menopause Month

Rosena Allin-Khan Excerpts

Thursday 21st October 2021 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I am proud of everyone who has spoken today. I thank my hon. Friend the Member for Swansea East (Carolyn Harris) for all her work on this important topic. She never ceases to amaze me with her tireless campaigning, which has earned her a formidable reputation across all our nations. Many issues divide us in this place, but we have seen the best of the House in this debate. We are here only because of the work of fantastic campaigners. In a short time, we have moved from hearing whispers of “the change” in people’s living rooms to addressing what real change is needed to support women. We are doing that here in such an important way.

It is only possible to reduce the stigma around the menopause by talking and listening as we have today. I thank all hon. Members who have contributed—men and women—on both sides, because they and their solidarity matter. Along with the many accounts we have heard, it has been incredibly important to read accounts of high-profile women realising that they are experiencing the menopause.

We have heard a heady mix of humour and heartfelt tributes today, but it is a daunting space to navigate. As a woman who has not yet entered the menopausal phase of her life, but who has been through starting a period, worrying about having children, having children and understanding her body, after today’s debate I feel less anxious than ever about a topic that many women find extremely worrying to talk about. We have celebrities to thank for raising awareness.

How many of us have never had those much-needed conversations with our families? For how many of us is it too taboo to even start discussing our periods, let alone have conversations about the menopause? It is damaging to our society that far too many women simply do not know what to look out for. More and more women are learning about the menopause from celebrity accounts. There is still far too much mystery around our bodies, despite making up 51% of the population, and that simply has to change.

It is our duty to tackle the misinformation about the menopause and HRT. I hope that this debate goes some way to addressing some of those myths. Better information about the menopause and HRT would likely mean that more women would receive treatment before their symptoms became debilitating. For example, we have heard about osteoporosis, as well as moving accounts of people living with serious mental illness and wondering why they do not feel like themselves. For many women, that lasts more than a decade.

It is important that we recognise GPs’ essential work and pay due thanks for it, but it is also important to address the lack of understanding that some GPs demonstrate. I have heard accounts of GPs refusing to diagnose women as menopausal, resulting in a frustratingly long drawn-out process that has led far too many women to give up and suffer in silence.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making excellent points. I first encountered the issue as a young woman writing a draft women’s strategy for a regional health authority in 1989, in which it did not feature. We hear much about strategies and the education of medics, but actually they have not transformed and changed in that time. Does she agree that they are important?

Evidence shows that osteoporosis disproportionately affects women with lower incomes and that there is huge variability of services across the country. Does my hon. Friend agree that that also needs to be addressed?

[Dr Allin-Khan]

I wholeheartedly agree with both of my hon. Friend’s points. In fact, we have heard today the statistics about just how much there is a lack of education about the menopause in medical school. It was something that we did not really talk very much about when I was at medical school. It is also really important to highlight the fact that we live in a very diverse country and a diverse society, where information has to be available in a number of languages and where there has to be proper outreach to communities in which people certainly would not think of speaking about it at home.

As I have touched on, the effect that the menopause can have on women’s mental health must not be ignored. It should not be underestimated. How many of us throughout our lives have been dismissed as hormonal, hysterical even, or too emotional? The hon. Member for Stourbridge (Suzanne Webb) spoke about her ex-ex, and I am glad to hear he is such, but unfortunately we do get labelled—women get labelled—as hysterical or hormonal as an excuse. I have actually experienced it at first hand right here at the Dispatch Box. Is it any wonder then that women are scared to speak about what is happening to their bodies?

Women who experience mood changes during menopause are often not taken seriously. The symptoms of mental ill health are often condescendingly brushed aside as simple mood swings or unnecessary aggression as a result of the menopause. The reinforcement of women as hysterical or highly emotional is incredibly damaging. No wonder some women feel they are unable to reach out for support. So many hon. Members have mentioned, so importantly, the workplace, and for so many women, support simply is not available. They are often forced to suffer in silence for fear of repercussions. This is at a time when women should be reaching their professional peaks in their careers—the heady heights of what it means to be a CEO, run a hospital, run a business or sit here in Parliament—but, instead, women are forced to make up excuses about why they are taking days off or feel that they have to take early retirement. Well, this has to end, because women are a powerful force and able to achieve anything at any point in their life, and it has been wonderful to have reminders of that today.

Besides a seismic change in attitude and an eradication of stigma, what action do we need to ensure real change to support women undergoing the menopause? We need menopause awareness training for employers to help reduce stigma and to ensure that women are getting appropriate support and advice. This not only benefits those with menopausal symptoms, but has economic benefits for employers and wider society by helping to improve productivity and reduce absenteeism. We need to ensure that medical professionals are able to recognise when women are menopausal so that HRT can be prescribed, eradicating the lengthy waits, and women must be able to access accurate information on menopause to dispel the myths once and for all.

I would like to end by again thanking every Member for their contribution today, and I eagerly await to hear from the Minister how the Government plan to tackle the stigma surrounding menopause and offer real support for women once and for all.

Oral Answers to Questions

Rosena Allin-Khan Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

We are hugely grateful for the tireless efforts of GPs and their teams throughout the pandemic. In our comprehensive new plan, which we announced last week, we are including a £250 million winter access fund to support GPs and make it easier for them to see and speak to their patients. A record number of GPs began training in 2021, and we are committed to increasing the number to 4,000 each year.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I start by paying my respects to Sir David Amess and James Brokenshire, who were sadly taken from us far too soon.

I welcome the Minister for Care and Mental Health, the hon. Member for Chichester (Gillian Keegan), to her new brief. I look forward to working with her.

We are all too aware of the growing demand for support across the NHS, but all too often mental health treatment is forgotten. With up to 10 million more people thought to require treatment as a result of the pandemic, with waiting lists soaring and with beds being cut, we need more than just warm words from the Government. Labour will guarantee treatment, not just an assessment, starting within a month, and we will recruit 8,500 new staff so that 1 million additional people can receive the timely treatment they so deserve. That is what came out of our conference from our party leader. There was nothing of equal value from the Prime Minister, bar recycled old pledges and money spent four times over. Why?

[Mr Speaker]

I call the Secretary of State.

Baby Loss Awareness Week

Rosena Allin-Khan Excerpts

Thursday 23rd September 2021 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

There is nothing that fills me with more pride than having the honour of following all the incredible speeches that have been made from both sides of the House today. There are so many things that divide us in this place, but is it not wonderful that this is not one of them? I thank everyone who has spoken today for their courage.

This annual debate is about having voices heard, and all who have spoken today have said incredibly moving things, but I want to pay tribute to a few people. I thank the hon. Member for Truro and Falmouth (Cherilyn Mackrory) for moving this debate. In you, Lily lives on, and she will always continue to do so.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) did Kenneth proud, and I know that 15 October will prove incredibly difficult for you, as I am sure it does every single year, but you hold him in your heart and we hold him in all our hearts. We will be thinking of him on that day. In bringing your passion to this debate, you are ensuring that the other mothers, fathers and partners who go through this do not feel alone.

The right hon. Member for South West Surrey (Jeremy Hunt), with his honesty, reminded us that grief is a lifelong process. The honesty in the words of my hon. Friend the Member for Pontypridd (Alex Davies-Jones) truly highlighted that the journey to parenthood can be fraught with challenges. It is often not easy to admit some of our dark thoughts about other people’s happiness or about the failures we may see in ourselves if we feel that we do not fall into the social construct that society has created for women.

I am going to answer the rhetorical question that the hon. Member for Bracknell (James Sunderland) posed about the validity of his being here and speaking today: yes, you should be speaking. It is important to represent everybody who has gone through the same lived experiences, and you brought them to the Floor of the House.

Turning to the hon. Member for Guildford (Angela Richardson)—my goodness—the guilt surrounding parenthood is so rife, and we must be kinder to each other in society. There is nothing worse than sitting in an NCT group full of people who delivered their wonderful babies in a water bath when you went through a crash C-section and feel like a failure, crying into your cake as you wonder what is wrong with your body that meant that you could not give birth in a bath with some whale music. What you highlighted today shows us the importance of understanding that the journey through the birth process does not end once you have given birth. We have to look after each other and keep an eye on people’s mental health.

It is so important that we talk about stigma. I know about this from my work as a doctor in the emergency department over the last 16 years. I have seen countless parents come into that department. I have seen a mother, bleeding, pleading with me to tell her whether she is losing her baby, and I have known the heartbreak of performing the examination and either confirming her very worst fears or sometimes, even worse, saying, “I do not know—and I am really sorry, but it is Friday afternoon and you will have to wait for your scan on Monday morning to find out.” I see mothers who ask, “Did I eat the wrong cheese? Did I exercise too much? Should I have given up work and just stayed at home? Have I done this, doctor, have I done this?” No, you have not.

I say to every mother who is watching the debate today and asking herself if she has done something wrong, “You have not done anything wrong. Your baby was loved; your baby was wanted; you did everything right.” It is so important that we support mothers on this journey—mothers who are living with the guilt, living with the stigma, wondering if people are thinking to themselves, “Well, she clearly did not read the rules properly. We seem to have managed just fine.” To every mother who worries about that, I say, “You are not alone.” I thank all the charities that are out there doing such incredible work to eradicate the stigma, but there is still so much more to do.

To all the partners—supportive partners—who are told not to share their emotions, and told that their emotions are not as valid because they were not carrying the child, I say, “That is rubbish.” They are told not to acknowledge their grief, and are encouraged just to go back to work. It is a case of “Stiff upper lip—these things happen.” I say to them, “You are entitled to grieve. You are entitled to feel every single emotion that is due to you, because these are your emotions and that is your right.” Everyone does it differently: there is no one-size-fits-all model. We have to understand, and our health services have to be built to have a capacity that understands the nature of grief and understands that it is different for everyone. However, when we are doing this together here today, we are already going some way towards breaking down that stigma, and we are breaking it down every year when we have this debate.

It has been an incredibly difficult 18 months, and people’s experiences of baby loss during this time have been incredibly heartbreaking. During the pandemic there has been reduced access to face-to-face appointments, and when appointments have taken place in person, partners have been excluded, leaving women to receive the very worst of news on their own. Expectant fathers pace the car park, wondering when they will be allowed in to hear that very worst of news. Women are often forced to take decisions alone. I want to thank the NHS staff who have worked tirelessly throughout the pandemic, and have had to go above and beyond when visitors were not allowed into hospitals following a loss. However, I also want to highlight the important fact that there are babies that are lost when the loss could have been avoided. In the House we discuss many cases in which loss cannot be avoided, but this is not one of them.

That leads me on to the importance of inequalities in this debate. It is the saddest fact of all that where a family live and how socioeconomically well off they are can determine the likelihood of their baby’s surviving or not. Black and ethnic minority women are more likely to deliver by emergency caesarean section and less likely to have pain relief during labour, and receive fewer home visits from midwives. Stillbirth rates for black babies, including black British babies, were over twice those for white babies, while neonatal death rates were 45% higher. Black women are still four times more likely than white women to die in pregnancy or childbirth in the UK. With an ongoing inquiry into systemic racism in NHS maternity services, we must ensure that action is taken to eradicate these gross disparities. We need change now: women cannot and should not wait any longer. It is not acceptable, and these families deserve better. Many of us will have heard stories of women who were told that they needed an extra scan between the 20-week scan and giving birth, but professionals were concerned that because they were Muslim they might want to sex-select, and they were therefore denied the scan. That is atrocious. Preventable deaths have occurred because of such practices, and they must be eradicated.

Research published last week found persistent inequalities for ethnic minority women accessing mental health care after giving birth. It found that 98% of women were willing to be treated for their mental health, but one third had not received any treatment. including talking therapies such as cognitive behavioural therapy or counselling. About one third of the women surveyed felt that

“receiving treatment for emotional or mental problems carries social stigma.”

We have to understand, in our multicultural society, that everyone deals differently with mental health matters, particularly in relation to having children. We must have services that are able to handle the differences in our communities.

The major treatment stigma-related barriers to accessing services were found to be women’s concerns that they might be seen as “a bad parent”; not wanting mental health problems to be on medical records; concern that their children might be taken into care; and concern that they might be seen as “weak”. Those are the voices that we need to recognise today. We are in a place of privilege. We can stand here and talk about our experiences, people can learn from them, and we can feel that we are doing our bit to deal with our grief, but what about all those thousands of women’s voices across the country that are not heard? Today we are speaking for all of them as well.

Post-natal depression or anxiety in black, Asian and ethnic minority mothers is 13% higher than in white mothers. A 2011 study found that black women are the group least likely to initiate treatment for post-natal mental illness, and the least likely to receive follow-up treatment. We must do better, we can do better, and I truly believe that there is a collective will across the House to do better.

Let me ask a few questions of the Minister, whom I welcome to her place. Will bereavement support after the loss of a baby be standardised to avoid the postcode lottery that too many families experience? No one should have to lose three babies to receive miscarriage support; what are the Government doing to ensure that people have the support they need when they need it, not after miscarriages? Has data begun to be collected on miscarriage, stillbirth and pre-term rates, and if not, will the Government commit themselves to that? What is the current progress on the women’s health strategy, and who from the Government will be taking this forward following the reshuffle?

By talking about these issues so openly and honestly, we work to remove the stigma surrounding them. The pandemic has undoubtedly brought additional barriers that make the experience of losing a baby even more isolating, but it is stigma and the lack of understanding that can make people feel most alone. I will finish, as the hon. Member for Cities of London and Westminster (Nickie Aiken) did, by saying to anyone watching today: you are not alone.

Future of the National Health Service

Rosena Allin-Khan Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is such a pleasure to serve under your chairwomanship today, Ms Bardell. I want to declare an interest: I am proudly an NHS doctor and have been for 16 years.

It is an absolute pleasure to wind up today for the Opposition. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for securing this hugely important debate, and I thank all hon. Members for their thoughtful contributions and suggestions. My hon. Friend the Member for York Central (Rachael Maskell) reminded us of the inequalities that are already deeply rooted in our society, and my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) spoke movingly about residential care. My hon. Friend the Member for Rhondda (Chris Bryant) spoke about the value of our NHS staff, and my hon. Friend the Member for Wirral West (Margaret Greenwood) reminded us in no uncertain terms how life looks without the NHS. My hon. Friend and neighbour the Member for Streatham (Bell Ribeiro-Addy) spoke of the privatisation by stealth that she already sees in her community and the detrimental impact that it will have.

There is no institution that unites us quite like our NHS, and it represents the very best of our values: collective, compassionate and co-operative. Our health service was once the envy of the world and laid the blueprint for publicly run, universally free healthcare for the modern age. The outbreak of coronavirus reinforced the need not only for a universal health service, but for health services to be properly funded and fully resourced. I am in no doubt that we lost more lives than we needed to because of the drastic and protracted underfunding of our NHS over the last decade. The pandemic reminds us of the risks of Conservative underfunding and undervaluing of our NHS, leaving it ill-prepared to handle winter, let alone a global pandemic.

Despite our unwavering pride in our NHS, it has suffered a decade of decline under consecutive Conservative Governments, and we have already lived through a botched reorganisation in 2012, which was supposed to cut down bureaucracy and deliver better care for patients. Instead, the Lansley reforms had the opposite effect, by complicating processes and increasing the reliance on private providers. The reforms introduced market elements, putting shareholders and companies ahead of patients. Shame! The changes meant that services went out to tender to anyone, resulting in private companies competing against public ones to deliver care at a local level. Those changes completely fragmented our health service, creating a route for private companies to make a profit on community services.

The damage of that reorganisation is still being felt profoundly today. Waiting lists are skyrocketing and people are finding themselves stuck in A&E. Routine operations are being cancelled and cancer waiting times are not being met. Operations are being postponed at an alarming rate, and the backlog in mental healthcare is reaching an all-time high. We are letting down a whole generation of young people, who are so reliant on timely access to mental healthcare services.

Like my medical colleagues across the country, I have been in A&E to comfort young people with eating disorders, who are stuck there because there are no appropriate beds for them. They feel that they cannot trust anyone, because they continue to be passed from pillar to post. I have been with families who hope that their elderly relatives get discharged so that they can spend their final days at home. What must it feel like for a family who are waiting for the person they love to be discharged, just so that person can die with dignity at home and in the arms of those they love? Because of fundamental flaws in social care, however, they find that they cannot be reunited with and cared for by the ones they love. Shame!

We have seen a rise in the use of more expensive agency staff throughout the last 10 years, while nurses, doctors and porters have had their pay squeezed. During this decade of decline, we have also had the first doctors’ strike in the history of the NHS, with junior doctors forced to take industrial action because of contract disputes. The Government expect doctors to work longer for less. The last thing that we frontline NHS staff want to do is to strike. We want to be serving our patients but, sadly, the Government have given us no choice but to know that the best thing that we can do for our patients is to demand better pay and working conditions.

Our NHS staff have worked incredibly hard throughout the pandemic. Through each lockdown, each wave and each new variant, NHS staff have kept going, putting themselves at risk in order to keep us safe. The personal sacrifice is astounding, and we know that so many have paid the ultimate price with their lives. Staff are exhausted, burnt out and in desperate need of respite, and yet they are not receiving sufficient support from the Government. Throughout the pandemic, I have had medics, nurses and colleagues from all around the country messaging me in the middle of the night, unable to sleep from the stress that they have been put under and the amount of death that they experienced in such a short period of time. They were not trained for such conditions.

As hon. Members have said, it is no wonder that around a third of NHS staff stated in the most recent survey that they were considering leaving their jobs. With vacancies already high throughout the healthcare service, losing more staff would be absolutely catastrophic and would definitely impact on patient care. Healthcare staff need to feel valued and appreciated by the Government, but despite the sacrifices they have made and continue to make, their only rewards so far have been empty claps and a real-terms pay cut. If the Government truly appreciated the efforts of NHS staff, they would offer those staff a fair pay rise. The Government might also consider taking up my offer to work with them on a cross-party basis to address the mental health crisis among NHS and care staff. There is nothing I would like more than to work with the Government to deliver what our frontline NHS and care workers need.

On the subject of pay, fair pay is not simply a moral imperative; it is about the future functioning of our NHS. The NHS is one of the single largest employers in the world, but it is in the midst of a workforce crisis. By refusing to offer a fair pay rise, the Government risk causing workers to leave the health service. That would create more vacancies, further shortfalls of staff during shifts and increased workload for the staff who remain. We know that 56% of NHS staff already work unpaid additional hours, and that percentage will only increase if the workforce becomes even more stretched. It is a cycle that will lead only to further burnout among staff and eventually to more staff looking to leave. The Government have known for years that further action must be taken to recruit, retain and train more staff, yet nothing is being done at a fast enough pace to ensure that future demand will be kept up with.

Despite the mishandling of the NHS since 2010, it seems the Conservatives have not learned their lessons, because they are forcing through another reorganisation. The Health and Care Bill, like the Lansley reforms before it, fails to grasp the real challenges facing the NHS. It will only serve to create more problems, rather than solutions, and it will put our entire health service at risk. It does nothing to stifle the market forces present in NHS services, meaning that we will have more private companies running vital community services. A modern NHS has to take a whole-society approach, working closely with local authorities and other public services to reduce the inequalities that drive poor health. A joined-up approach would better serve communities, but the new Bill fails to outline how such an approach would be achieved, and that will result in more fragmented services and worse outcomes for patients. Instead of adopting such an approach, the Conservatives are more interested in consolidating power and guaranteeing private providers a voice in how local services are run.

As we look ahead to the future of the NHS, it is important that we never forget the principles on which it was founded: free at the point of delivery, publicly funded and publicly run, universally available and based on clinical need, not the ability to pay. The Conservatives, who voted against the creation of the NHS 22 times, have been working hard ever since to slowly erode the collective foundations on which it was built. We cannot let that happen. We must never, ever lose sight of the founding principles of the NHS, and we must never let the market control healthcare in this country.

Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021 Health Protection (Coronavirus, Restrictions) (Self-isolation) (England) (Amendment) Regulations 2021 Health Protection (Coronavirus, Restrictions) (Self-isolation) (England) (Amendment) (No. 2) Regulations 2021

Rosena Allin-Khan Excerpts

Monday 13th September 2021 General Committees

[Dr Rosena Allin-Khan (Tooting) (Lab)]

What a pleasure it is to serve under your chairwomanship, Ms McDonagh.

At the time of restrictions lifting, we opposed, and still oppose, the decision to remove the requirement to wear a face covering indoors and on public transport. Risk of transmission inside a crowded bus or train will be incredibly high. Last week, the Office for National Statistics believed that one in 70 of us in England had covid. The capacity of a double-decker bus is about 70, and a full tube or train carriage can carry up to 140 passengers, which means that last week each full carriage could have contained two infected passengers, with little ventilation and no legal requirement to wear a mask.

With no requirement to wear a mask coming from the Government, mask-wearing has dropped considerably. However, people learning to drive and their instructors are still required to wear a mask inside cars, although we do not require people to wear masks on a crowded bus. That makes no sense.

The explanatory memorandum to the statutory instrument states:

“The rationale for revoking these regulations is that the success of the vaccination programme means that at Step 4 we can move away from strict legal restrictions and towards personal responsibility and informed judgement.”

What assessment has been made of the rates of infection in areas where it is still compulsory to wear face coverings on public transport—for example, here in London?

We supported the removal of some restrictions on gatherings, but the Government did not have to go so far, so fast. The announcement that all limits were being removed again came too late, meaning that businesses were left to scramble owing to confusing and contradictory advice. Ministers have passed the buck to businesses and individuals with vague and unclear guidance encouraging, but not mandating, the use of masks, as well as the NHS covid pass.

The Government’s explanatory document states:

“Our assessment of the risks is not fundamentally changed by new Variants of Concern”,

but what about the rate of deaths and hospitalisations? There is talk of an October lockdown. What impact have these changes had on the rate of infection? Bars and restaurants have resumed service as normal, but what public health assessment has been made of transmission rates since social distancing was scrapped and face coverings were deemed not to be necessary?

Due to the unpredictability of the virus, it would be negligent completely to remove the ability to reinstate any restrictions if required locally, so we are pleased that regulation 3 powers for local authorities are being extended. However, the Government must back up local authorities with a proper package of support should they impose restrictions. Allowing local authorities to limit the capacity of venues and allowing them to mandate certain social distancing measures may become essential in preventing localised spreads. That may not have seemed necessary over recent weeks, but with cases, deaths and hospital admissions all rising, some local authorities might be forced to impose measures and the Government must—absolutely must—support those businesses and councils.

With contact tracing now voluntary, and with the requirement to book a table before entering premises removed, we are in the dangerously perilous position of not really knowing who is entering venues. During the summer, there has not as yet been a requirement for further restrictions, but with the winter months closing in, this type of contact tracing might become invaluable in battling a fourth wave if we are indeed to avoid lockdowns.

Removing that requirement altogether has meant that its importance has been lost to most people, and reapplying it would be an uphill task. It must also be said that while contact tracing in establishments could have been used effectively to target specific outbreaks of the virus, we know the Government did not really use the data and instead relied on the test and trace app. For a multi-billion pound test and trace system, I would have expected far more for my money.

There is no longer a need for people to check in at bars and restaurants, but is there contact tracing data that can be shared with us? How many new cases of covid have had their contacts successfully reached? One of the most important aspects of any contact tracing system is ensuring that anyone identified as a close contact of someone with the virus self-isolates as a precaution. However, the roll-out of the vaccine coinciding with the reopening of the economy requires that to be adapted.

We supported removing from people who were double-vaccinated and had come into contact with someone with covid the requirement to self-isolate, unless they returned a positive test, but that could have been done sooner. The Government had no real logic behind their chosen date in August and they still cannot explain why they chose 16 August when Wales and Scotland had removed the requirement a week earlier, enabling thousands of non-infected people to get to work. Someone who has been double-vaccinated is far less likely to get a serious infection from covid, and transmissibility is reduced as well.

Paragraph 7.7 of the explanatory note to the self-isolation statutory instrument stated that

“public health modelling suggests that the rise in case numbers we are experiencing will have peaked by mid-August so introducing this change then will reduce the risk of transmission, hospitalisations and deaths.”

However, that was not the case. Instead, cases continued to rise. What further assessment has been made of case rates? Following the scrapping of self-isolation among the vaccinated, what assessment has been made of the direction of travel of such cases? There is also an exemption from self-isolation for children. We are still early in the school year, but what assessment has so far been made of the spread of covid in schools this term?

Although we will not oppose the regulations, our concerns regarding certain aspects of them have been put on the record. I hope the Minister can provide answers to my questions. Fundamentally, these decisions must be driven by data and science, not pressure groups and lobbyists.

This has been an incredibly difficult time for everybody, and we understand how challenging it has been for people to self-isolate and to manage work with their children at home, but we must state that we know cases are on the rise. It is incredibly difficult to predict how case numbers will proceed over the winter months, so I would welcome answers to my questions so that we can ensure that the public are kept as safe as possible.

Covid-19: Immunology Research

Rosena Allin-Khan Excerpts

Thursday 9th September 2021 Westminster Hall

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is a pleasure to wind up for the Opposition with you in the Chair, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for securing this extremely important debate. I know he is hugely passionate about so many issues, and it has been wonderful to hear him set out exactly why this topic is so close to his heart.

So many heroes have emerged from this pandemic: our frontline NHS staff, shopworkers, carers, posties, delivery drivers—the list goes on and on. It is absolutely right that these people’s efforts are recognised, but today we have the opportunity to express our gratitude to a different group of people—a group that is more often found behind the scenes in labs and research facilities up and down the country. Their commitment and dedication to understanding and then eradicating deadly diseases has saved millions of lives over the last two centuries. Immunologists and all their colleagues in biomedical research deserve all the gratitude we can offer.

It is through immunological research that we can treat and prevent the spread of diseases. Although it can be difficult to remember a time when we were not consumed by information surrounding covid, it is important to remember how we got here so quickly. Without this research, we would not be able to develop vaccines or even understand basic principles in reducing infection rates. This work allows us to identify who is most at risk of certain diseases and informs both public health messages and interventions to limit outbreaks.

The work of immunology researchers and scientists led to an almost immediate understanding of this virus. We understood how to limit its spread and, ultimately, how to develop a vaccine to stop it. Considering that very little was known about the coronavirus before it began to spread ferociously around the world, this achievement is even more remarkable. Without this work and dedication, the loss of life worldwide would be far greater. For that, we already owe a huge debt.

It is only right to begin my contribution today by paying my respects to those who work in this field. In particular, I pay respect to the British Society for Immunology and the Royal College of Pathologists. I am sure colleagues will join me in doing so. Those institutions refused to be fazed by covid-19, and the work of their members has been pivotal in delivering a route out of the pandemic. We have a long and proud tradition in this country of pushing advancements in medicine, especially on immunisation. The work of UK scientists has led to vaccines being developed for numerous infectious diseases.

Edward Jenner, often referred to as the father of immunology, discovered the first ever smallpox vaccine in 1796. It had been theorised that exposure to cowpox would protect against infection with the more lethal smallpox. Jenner tested this theory and it was a resounding success. A tribute to Blossom, the cow whose cowpox was used as the first vaccine, can still be found on the wall of the St George’s medical school library, which is attached to the hospital where I work. From that achievement in 1796 to covid vaccines today, we should be proud of this legacy.

The scientific community has always fully endorsed collaboration and working across borders and cultures to foster innovation. Let us be clear: the unsung heroes are our scientists, who went to work day and night throughout the pandemic, even though they were putting their own lives at risk and were concerned for their own families. They are the reason we have a vaccine today—a vaccine that has saved so many lives. For them, we are truly grateful. By collaborating with researchers all over the world, UK scientists have played their part in preventing deaths from some of history’s deadliest diseases. These efforts have resulted in no less than 26 vaccine-preventable diseases, and are estimated to prevent over 2 million premature deaths globally every year.

I am proud to be part of the UK scientific community—as, I am sure, are you, Dr Huq. I am truly honoured to have met so many of the specialists who have been relentless in their struggles to get a handle on covid-19. It is imperative that the Government do all they can to support this work and to facilitate as much international collaboration as they can during the final stretch of covid-19 and long beyond. Despite all we have learned about the virus, there is still so much we do not fully understand: exactly how long immunity lasts following vaccination and whether immunity completely prevents individuals from passing the virus on, or simply prevents them from developing symptoms. Research into those questions is, of course, ongoing, and as greater numbers are vaccinated we should be in a better position to answer them.

With the ongoing threat of new variants emerging, it is vital that we understand their potential effect on immunity. Closely monitoring new variants and their impact on our immune system will help get us to a position whereby we can begin to control the virus and exit the pandemic. It is easy to assume that, now that we have a vaccine, the hard work is over and life will inevitably return to normal. While that is what we all strive for, we cannot allow complacency to creep in. By continuing to support the work of immunologists, pathologists and the wider scientific community, we will be able to face any new emerging challenges and react accordingly.

The UK is a global leader in immunology and infectious disease research, both in the academic environment and in our industrial capabilities. We need to build on those strengths and invest in our workforce, who are the lifeblood of the discipline, to ensure that excellence continues to be recognised at home and abroad. I would be grateful if the Minister could commit to this and outline what support the Government will provide for this highly skilled workforce.

Now is the time to encourage people to take up careers in this field. We need to attract high levels of talent from around the world, while training and developing our own staff and encouraging them to forge long and successful careers here. We must continue to break down the barriers in STEM to ensure that immunology has a representative workforce who can inspire future generations, regardless of their gender, ethnicity or class.

The response from the research community to covid-19 has been immense, but it has also highlighted the need to be better prepared for the next pandemic, whatever it may be and whenever it may come. Governments around the world recognise that and must never lose sight of it. Here in the UK, we cannot afford to take our eyes off the ball. Doing so would jeopardise the results of the sacrifices we have all had to make over the past 18 months, including those in our scientific community. I implore the Government to continue to support our world-leading biomedical science sectors long after covid becomes a distant memory. We were not as prepared as we could have been for the virus’s onslaught. We must learn from that and ensure that we are better prepared for the next threat, even if we do not yet know what it will be.

[Dr Rupa Huq (in the Chair)]

Finally, from the Government, Nadhim Zahawi. It is good to see him in person, and not on a conference call on a Friday.

NHS Update

Rosena Allin-Khan Excerpts

Wednesday 21st July 2021 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I declare an interest as an A&E frontline doctor who is working in our NHS.

The contempt that the Government have for the House is unacceptable. I had advance sight of the statement only a few minutes ago. Once again, the Government have had to row back on a shoddy, ill-thought-through position, with their 1% pay rise—a real-terms pay cut—rejected by the independent pay body. What do they do? Nothing. Less than an hour ago, there were competing briefings on what the deal was going to be, but it turned out to be nothing. Our NHS staff deserve better than this. They have worked incredibly hard throughout the pandemic, and their personal sacrifice is astounding. Their hard work never stops, and that is not without consequences. Work-related stress has increased by nearly 10%, and mental health is consistently the most reported reason for staff absence in the NHS, accounting for approximately half a million days lost every single month.

Those issues preceded the pandemic, but the increased pressure, intensity and trauma experienced by staff has taken its toll. Reports published in January found that nearly half of frontline NHS staff were suffering with post-traumatic stress disorder symptoms and severe depression, with many drinking to numb the pain. It is hardly a surprise that a third of staff are considering leaving their job. With vacancies throughout the health service, retaining staff is absolutely vital, especially when the NHS is embarking on a vaccine booster campaign, tackling the coming wave of coronavirus hospitalisations, treating the growing number of long covid cases, and dealing with the ever-mounting backlog.

That is why a fair pay rise and conditions are important. It is not just a moral imperative—it is also about the future functioning of our NHS. By refusing to offer a pay rise, the Government risk workers leaving the health service, creating more vacancies, shortfalls in shifts and increased workloads for the staff who remain. It makes recruitment much harder, with huge gaps in crucial areas such as nursing. It makes the Government’s already insufficient pledge to recruit 50,000 more nurses by 2024 simply impossible. Healthcare staff are rightly angry that they have been treated in this way. We recognise that unions want to consult their members on all proposals, and we support them in that. The fact that even the unions have been kept in the dark is utterly unacceptable.

After the year we have had, there should not be so many unanswered questions, so I ask the Minister: is this really fair on NHS staff who have had to bury their colleagues, as well as their families? Is this really fair on NHS staff who have been sent like “lambs to the slaughter”, without appropriate personal protective equipment for work throughout the pandemic—I am using their words. Is this really fair on NHS staff who are sent to support us and our families, ill-equipped and with inappropriate PPE? Is this fair, when NHS staff nursed our loved ones when they died alone? Is this fair, when staff are exhausted and there is still no end in sight. Minister, this is quite simply an insult of the highest order. After everything our NHS staff have done for us, when will the Government finally make them feel valued and offer them something more than claps?

A statement on the NHS should have concrete plans on how the Government will support the NHS in tackling the summer crisis. If the Minister is so sure that she understands NHS staff and their pressures and workloads, I invite her to do a shift with me on the A&E frontline—she can shadow me for once.

National Health Service

Rosena Allin-Khan Excerpts

Tuesday 13th July 2021 Commons Chamber

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Since the start of the pandemic, our lives have all been deeply affected. Our key workers have experienced more than their fair share of grief, strife and sacrifice. Our care staff have truly been the best of us during the past 16 months, nursing our loved ones at the end of their life, being the person who holds our relatives when they are scared and confused, and facilitating greetings through windows and fences and across roads. They have been family to our vulnerable relatives over the past year, and for that I will be forever grateful. I do not think we will ever be able to repay that debt.

These are not the words of a politician or even a doctor; they are the words of a daughter who had to say goodbye to her father during the pandemic. I am eternally grateful for the care my father received, which went above and beyond what I could have expected. Carers showed my family and me what humanity truly is: changing their shifts to be with him, being on the end of the phone whenever we needed them, and facilitating whatever they could for us to be with him in his last moments. I can never repay my father’s carers for the humanity that they showed him as his condition worsened while my family could not be by his bedside.

Carers were scared, and many still are. The idea of passing a deadly virus on to the people in their care tormented them, and that is why we are here today. The idea that care workers do not think about the day-to-day safety of the people they care about is an insult. From my own experience, I know that their residents are of the utmost importance to them. So often poorly paid, they put in the gruelling work because they truly care. To argue that they do not neglects their fears. We want everyone working in a care home to take up the vaccine, which is safe and effective, but we are not inclined to support these proposals or 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. This would have disastrous consequences for the quality of care. It is vital that we examine the current reality of life on the frontline in care settings. During the pandemic, Unison surveyed its members, who shared that they were feeling more anxious and depressed than before owing to the fear of passing the virus on to their relatives and those under their care. Many felt that their management were not equipped to support their needs. Resoundingly, care workers just wanted people to listen to their experiences and the challenges they were experiencing without, and I quote, “fear of being singled out as a troublemaker”.

[Rachael Maskell]

I am really grateful for the speech that my hon. Friend is making and obviously pass on my condolences to her. Does she agree that after all that our care workers have been through, what they need at this time is not only supported conversation about how they can progress with their own vaccination, or not, but to have the right people in place giving them that supported conversation?

[Dr Allin-Khan]

It is almost as though my hon. Friend has read the rest of my speech. I could not agree more.

We have to listen to our care workers today. For the young, pregnant carers worried about their next pay cheque, will these proposals make them more secure? For all those carers from communities who have lost trust in authority, will the threat of losing their jobs instil more trust? For all those carers who have loved and cared for their residents but have concerns about the vaccine and have not had anyone answer their questions, are they being told that their dedication is suddenly irrelevant?

To understand why there may be hesitancy among care home workers to take up the vaccine, it is important to understand the health inequalities that much of the workforce face. Ethnic minorities are over-represented in the adult social care workforce, with 21% of all care staff coming from a minority ethnic background. Negative experiences of a culturally insensitive health service, the higher rates of death from covid for people from black and south Asian communities, and a lack of representation of minority groups in vaccine trials and wider health research all serve to build distrust in the health system. These are some of the communities that have been hit the hardest during the pandemic.

The disproportionate use of coercive and restrictive practices on minority communities also, importantly, erodes trust in the system. Black people are four times more likely to be detained under the Mental Health Act 1983 than white people, despite making up a much smaller percentage of the overall population. With trust so low, that creates hesitancy, but this can be overcome through effective communication and an understanding of the issues that have created it. Further coercion and punishment through the threat of being dismissed from employment only reinforces the reasons for hesitancy in the first place.

[Steve Brine (Winchester) (Con)]

I hear what the hon. Lady is saying. My first instinct on persuasion, months and months ago, was exactly the same, but more than seven months on, it has not happened. I am tempted to ask, “If not now, when?”, to coin a phrase. What is her response to that?

[Dr Allin-Khan]

My response is that the Government have not gone far enough to have these conversations. A real effort has not been made to engage with the communities that have been hit the hardest and for whom vaccine hesitancy is at its highest. Trust being so low creates the hesitancy that I have just spoken of. This hesitancy can be overcome through effective communication, but that has not yet happened under this Government’s watch.

[Several hon. Members rose—]

[Dr Allin-Khan]

I am going to make progress, thank you.

These measures will disproportionately punish groups whose needs are already rarely reflected in mainstream health services or the labour market. Respectfully listening to concerns and offering practical support would not only tackle vaccine hesitancy; it would also help to rebuild trust in health services, which in turn could eventually lead to reduced health inequalities for all minority groups.

Let us be clear: vaccine hesitancy is entirely different from being an anti-vaxxer. Vaccine hesitancy is a challenge for the Government to tackle. It is harder work. There is no quick fix. The Government are trying to make an incredibly complex issue into a black and white one, and that does nothing to pay respect to the sacrifices that care workers have made since the start of the pandemic. More must be done to encourage uptake of the vaccine.

[Dr Luke Evans]

Will the hon. Lady give way?

[Dr Allin-Khan]

I am going to make progress, please.

The UK Government should learn from the fantastic work of the Labour-led Welsh Government, who are running the fastest vaccine programme in the world and have vaccinated a far greater proportion of their staff than England; yesterday’s figures showed that almost 95% of care home residents and 88% of care home staff are double vaccinated. Wales has rejected compulsory vaccinations and instead chosen to work closely with the care sector to drive take-up, as well as valuing the workforce with a proper pay rise. That is the sort of leadership that is needed here.

A failure of leadership here will place the care sector in an even more precarious situation, with even fewer staff than at present. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes. That would have disastrous consequences on the quality of care. More than 100,000 posts in the care sector are currently unfilled, with recruitment and retention already extremely difficult due to low wage levels for difficult and demanding jobs. Not only could this plan have a disastrous impact on those relying on care, but the stress and trauma placed on their relatives will affect so many across the country. We already have a social care crisis. Let us not deepen it.

These proposals are at odds with the Government’s decision to throw caution to the wind by making social distancing and mask wearing optional and up to individuals to decide on. It makes no sense. Surely forcing workers to receive a vaccine is at odds with the individualism that the Government seek to promote at every opportunity. It seems odd that care workers are being singled out. Why is there a different rule for them? Are the Government hoping that the public will simply forget about their failure to protect care homes over the past year? Is that what is going on here?

Forcing carers to choose between losing their job and taking a vaccine that they are afraid of is inhumane. These are people who often work for less than the minimum wage. They are incredibly vulnerable people and their voices must be heard. Many of these people have lost multiple family members during the pandemic. They are being asked to put their faith in a vaccine that they are afraid of. The Government need to be doing more to tackle misinformation, promote the positive benefits of taking up the vaccine and support care home staff to do so. They have not been doing enough to support care workers who have done so much during the crisis. They should be focused on driving up standards and staff retention by treating care workers as the professionals they are, with improved pay, terms and conditions and training.

We have a moral imperative not to force people to take a vaccine that they are afraid of, so I urge the Government to listen to our care workforce. Surely they deserve at least that after the last year.

[Madam Deputy Speaker (Dame Rosie Winterton)]

This debate finishes at 7.19 pm and I need to bring the Minister in at the end. That means that if colleagues speak for between four and five minutes, everybody will get in. If colleagues do not speak for between four and five minutes, everybody will not get in.

Oral Answers to Questions

Rosena Allin-Khan Excerpts

Tuesday 13th July 2021 Commons Chamber

[Sajid Javid]

We have put more and more capital into the NHS. There are always representations from hon. Members, including you, Mr Speaker, for even more capital. My hon. Friend is right to raise the issue of the importance of local healthcare systems, which will need more capital funding as we progress. She will know that we set out our capital plans for this financial year, 2021-22, but she is right to say that multi-year funding will mean that trusts can plan better, and that is a priority; we want the spending review to have more sight and better planning for capital.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Let us consider these words about mental health services:

“prior to 2017, no government invested in or prioritised MH services.”

Those are not my words but the words of the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries). Indeed, the new Secretary of State was the architect of these cuts, during his time as a Treasury Minister. The unparalleled devastation he left behind has been simply staggering, so does he agree with his Minister? Can he explain to us why 140,000 children were turned away from mental health services last year? Can he explain why a quarter of mental health beds have been cut since 2010? Is he ashamed of his track record?

[Sajid Javid]

The hon. Lady will know that the NHS long-term plan that has been set out by this Government is committed to a transformation in mental health services and mental health spending; some £2.3 billion extra is being invested by 2023-24. In addition, she will be aware of the mental healthcare White Paper and the mental health recovery action plan. I hope these are all initiatives she will support.

Children and Young People’s Mental Health

Rosena Allin-Khan Excerpts

Wednesday 16th June 2021 Westminster Hall

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is such a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Twickenham (Munira Wilson) for securing extremely important debate and all hon. Members for their thoughtful contributions.

My speech is full of stats. We have heard stats and real-life stories. We know what has been unfolding in our communities. Today, we have a choice to do something about it. The Government have a choice to do something about it. What are we going to do? We are going to make our interventions, state our cases, speak the numbers. The Government will respond and then we will go back to normal, with children attempting to throw themselves off bridges; a reality where parents have to take time off work or give up work because they are so worried about their children who are self-harming. We are going to go back to teachers who would walk over broken glass for their students, desperately telling me that they cannot get their children on to CAMHS waiting lists. Even if they are lucky enough to tick those boxes and get on a list, it is far too long until they are seen.

Today, we have the choice to do something about this. Demand for mental health support is at an all-time high, yet access to services is simply not keeping up. For over a year, Labour has warned that children’s mental health should not be forgotten in this crisis, but it is easy to blame the coronavirus pandemic for what we are seeing playing out in our communities—every single community. This issue cuts across the class and socio-economic divide. It can affect any child or young person. Prior to the pandemic, access thresholds in many places were so high that they created unacceptable waits and led to children having their referrals cancelled without treatment.

The former Children’s Commissioner outlined in her 2021 annual report that over half a million children and young children were referred to CAMHS in 2019 and 2020. Of those, approximately 3,500 either had their referral closed or were still on the waiting list by the end of the reporting period. This simply is not good enough.

The pandemic has pushed services that were once stretched to breaking point over the edge. The Minister does not need to take my word for that, but she should certainly heed the warning from the NHS mental health trust leaders surveyed in May this year. The survey, carried out by NHS Providers, found that two thirds of trust leaders said they were unable to meet demand for CAMHS. Every leader surveyed stated that demand for children’s and young people’s services is higher now compared with last year. Some 78% said they were extremely or moderately concerned about their local system’s ability to meet the level of demand over the next 12 to 18 months, and 84% of trust leaders said children were waiting longer for treatment than they were six months ago.

The Government know all these stats. The Minister knows all these stats. What is she going to do about it? Is she going to recycle yet more money in a new announcement? Is she going to spend £2.3 billion over and over again in every debate that we have, depending on exactly which mental health topic we are talking about? The NHS does an incredible job with limited resources. However, it needs the political will to close the gap, now more than ever, and workforce capacity is often cited as the biggest barrier to scaling up provision.

That has been known for some time, with not enough being done to rectify it. Failure to resolve the issue before the pandemic is now having disastrous consequences. Mental health trusts had to give money to local hospital trusts to plug gaps, leaving them with even less of the money that they needed. This, on top of 11 years of an austerity-driven agenda, means the money is simply not in the system, and anything put back into the system will simply not cut it.

Staff have been grappling with a health emergency for more than a year, under enormous pressure, resulting in the acceleration of burnout and exhaustion. They are in desperate need of a reprieve, but the mental health fallout from covid means that waiting lists continue to pile up. Without urgent action, that gap in access will only continue to grow, leaving thousands of children to fall through the cracks.

National and crisis provision are extremely important, but more must be done to ensure that support is proactive, holistic and community-led. The biggest driver of poor mental health in children is adverse childhood experiences —I can see colleagues nodding. That is a well-known fact. When I do a shift in accident and emergency, and a child comes in with mental health issues—a child I have seen multiple times in the previous year, living in mouldy housing, in multi-occupancy homes, with parents who cannot access jobs—it is no surprise to me that they are suffering with their mental health.

What will the Government do about that? In areas of deprivation, it is not uncommon for parents to resist answering calls from withheld numbers or opening letters labelled private and confidential, but that is the main way in which CAHMS appointments are communicated to parents. Many miss the appointments, despite them and local advocates having pushed for treatment for many months and even years. Those children, the poorest and the hardest hit by other Government measures, then get dropped, which unfairly creates the impression that parents simply do not care. Those same parents are often grappling with many children suffering with mental ill health as a result of their life experiences.

Advocates out there would give the shirts off their back and, as I said, walk across broken glass to get those children to appointments. A fully holistic approach would include in a child’s referral the GP and school, where necessary. In areas where mental health is less understood, or cultural or language barriers exist, many children will attend a CAMHS appointment with mum and dad after the school has referred them, but because of a lack of understanding, mum and dad cannot explain the issues that their child is facing, so no course of treatment is started and the child is taken off the list.

These are our most vulnerable children, and often the children who need our help the most. What will the Government do to make services accessible for such children and their families? The scars that children live with forever means that those with the best English and a better understanding get the treatment they need, while others fall through the cracks. Many of us serve communities where that is the case, and it is no surprise that, despite being four times more likely to have a mental health problem than their affluent peers, children from the poorest backgrounds are much less likely to access services. A more joined-up, proactive approach between education, health and local authorities is needed, with greater focus on prevention and early intervention.

Talent is everywhere, but sadly opportunity is not. That is why the Labour party announced a children’s recovery plan to ensure that children can continue to play, learn and develop in the post-covid period, no matter where they are from, or what school they go to. That programme is meant to support children and young people throughout their education, and to recognise that positive mental health and wellbeing can be pivotal for children to reach their fullest potential. By tackling food poverty in schools, guaranteeing quality mental health support for pupils and fully funding extracurricular clubs and tutoring, each child would have an equal chance to succeed.

The Government know we are facing a mental health crisis. That is not news. We have whole communities full of people who are desperate for support—parents, teachers, families, children, desperate for support. They are counting on us to use the debating time today to make real, effective change. They do not want just rhetoric—just empty words and gestures, the same old recycled announcements time and again—but an acknowledgement that the Minister has today listened: listened to the pleas from those with eating disorders; listened to those who are suicidal; listened to those unable to access CAMHS services; listened to those who have waited far too long for the help they need and deserve; and listened to people who are unable to reach their fullest potential because they have a Government that do not understand the scale of the issue.

The time for dither and delay is over. I look forward to the Government announcing some real, tangible change.