Medical Cannabis under Prescription

Sandy Martin Excerpts

Monday 20th May 2019 Commons Chamber

[Jeff Smith]

My right hon. Friend makes a good point.

The Minister’s letter said that cannabis should only be prescribed where there is

“clear published evidence of benefit…and need…and where established treatment options have been exhausted”.

My question to the Minister is, do we really think all those hurdles are correct? If cannabis is the best treatment for a condition, we should not have to exhaust all those other options; we should be able to trust our clinicians to prescribe in such circumstances.

The root of the problem is clinicians’ lack of confidence to prescribe. The biggest barrier is concerns over the evidence. The Government have issued a call for evidence and research, but they are insisting on randomised controlled trials, which bothers me greatly. I am really concerned about the insistence on evidence from randomised controlled trials, to the exclusion of other ways of gathering evidence. I strongly advise Ministers and others to go back and look at some of the evidence recently given to the Health and Social Care Committee by Professor Mike Barnes, who is a noted expert on this subject. He has produced a study on the evidence for the efficacy of cannabis for a variety of medical uses. There is plenty of evidence around the world for the efficacy of cannabis for medical use. However, we are not accepting that evidence because it has not been produced in randomised controlled trials.

In his evidence to the Health and Social Care Committee, Professor Barnes said that we are trying to force cannabis into a particular pharmaceutical route with regards to trials, when that is not an appropriate way to go. He said,

“cannabis is not just cannabis…Cannabis is a whole family of plants”

and

“it does not lend itself very well to the standard pharmaceutical approach. It is not a single molecule that we can compare against a placebo. There are over 2,500 varieties of cannabis, each with a different structure…each with subtle differences.

He told the Committee that each variety interacts with the others differently. So which one of those varieties do we pick for our randomised controlled trial for a standard pharma model?

Professor Barnes said that we need to take a range of other evidence into account, including anecdotal evidence. When there are tens of thousands of anecdotes that build an evidence base, there is substantial anecdotal evidence for the efficacy of cannabis for medical approaches around the world.”

[Sandy Martin (Ipswich) (Lab)]

First, is it not also the case that we are talking not just about therapeutic uses, but about pain control? There are many conditions where pain control is actually the most important use of a medication. Secondly, may I add my recognition of the work done on this issue by the former Member for Newport West?

Diabetes: Artificial Pancreas

Sandy Martin Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr George Howarth (Knowsley) (Lab)]

I would like to begin with some acknowledgements to those who contributed towards the material that I will be using today, so let me place on record my thanks to Dr Jacq Allan from Birkbeck University and the charity Diabetics with Eating Disorders; Sandie Atkinson-Goulding; Dr Weston and Dr Zaidi from the Royal Liverpool University Hospital; the Juvenile Diabetes Research Foundation; Incisive Health; and Diabetes UK. I thank them all for sharing their expertise, briefing notes and academic work with me.

I intend to highlight the technology that is available for people with type 1 diabetes, point out some issues surrounding access to technologies and say a few words about the lack of structured education and psychological support available for type 1 diabetics. To conclude, I will make some suggestions to the Minister on what the Government can do to progress towards artificial pancreas systems.

Type 1 diabetes is an autoimmune condition, where an individual cannot naturally produce insulin. According to JDRF, this condition affects 400,000 people in the UK, of whom 29,000 are children. JDRF is leading on and funding the design of an artificial pancreas, which will change the lives of those affected by type 1 diabetes considerably. The artificial pancreas is in advanced human trials and the work in the UK is being led by Professor Roman Hovorka at the University of Cambridge, with funding from JDRF. Artificial pancreas systems automate blood-sugar management, dramatically reducing type 1 diabetes-related risks and improving the lives of people who have the condition. The artificial pancreas consists of a continuous glucose monitor, a computer programme and an insulin pump that work together to automatically control background insulin levels. These artificial pancreas systems, which may be a combination of existing or newly developed continuous glucose monitoring systems and insulin pump technology, have been termed the “artificial pancreas” because they monitor and adjust insulin levels just as the pancreas does in people who do not suffer from diabetes. Artificial pancreas systems have the potential to transform lives, particularly for those who find it difficult to maintain good blood-glucose control.

[Sandy Martin (Ipswich) (Lab)]

Does my right hon. Friend agree that simple continuous glucose monitors that are already available—I believe the Prime Minister wears one—are still not being allowed to children and young people who would benefit from them because some clinical commissioning groups do not prescribe them? When I asked the Secretary of State about this affair, I was told that the Department has no intention of monitoring what CCGs measure. Does my right hon. Friend agree that that is not a satisfactory state of affairs?

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. He is right in what he says, and I will be covering precisely that point later in my speech.

A recent JDRF-funded trial found that the artificial pancreas is better at helping people to manage their glucose levels than the best currently available technology. People who used the artificial pancreas spent 65% of time with glucose levels in range, which compares with 54% of time for people using a continuous glucose monitor and an insulin pump. Unfortunately, as my hon. Friend mentioned, there are significant regional variations in access to existing diabetes technologies, such as insulin pumps, in many parts of the country. The most recent national diabetes audit, published in July 2018, shows that although the overall uptake of insulin pumps has increased, the proportion of people with type 1 diabetes attending specialist services who are treated with pumps varies from a pitiful 5% to 40% at best.

--- Later in debate ---

[Mr Howarth]

My hon. Friend is right, and I did highlight earlier that I was unable to get statistics, either centrally or at CCG level. It is important that we collect more data, interpret it properly, and use it to inform policy.

Secondly, there should be mandatory funding accompanying any positive guidance from the National Institute for Health and Care Excellence as part of a technology appraisal, and a national clinical consensus pathway that covers artificial pancreas technology, with NICE incorporating that into commissioning guidance. That sounds very bureaucratic, but if it was taken seriously, it could have a major positive impact.

Thirdly, there should be progressive procurement policies that recognise the value, within the foundations of artificial pancreas policy, of innovations such as continuous glucose monitoring and insulin pump therapy. We should encourage continuous glucose monitoring with integration capacity, and insulin pumps that have artificial pancreas potential. I would also encourage continued innovation in diabetes technology. If we are to progress towards an artificial pancreas, the foundations need to be better established across the country; that is in addition to the changes I have highlighted. A 2018 audit of the use of insulin pumps showed a positive increase in usage, but also highlighted a wide disparity between specialist services, which we have already mentioned.

[Sandy Martin]

Is it not the case that in CCG areas where specialist pumps and continuous glucose monitors are prescribed regularly, the amount of emergency care needed for people with type 1 diabetes is reduced? Not investing in those things makes no financial sense whatever.

[Mr Howarth]

My hon. Friend is right. This is not just about technology, important though that is. Anyone with diabetes who manages it well—and technology will help to do that—will have fewer hospital emergency admittances. I do not have the statistics to hand—I am not even sure they exist—but those people will clearly have fewer hospital admittances and fewer complications with their diabetes, and therefore cost the NHS less. As I am sure the Minister will acknowledge, however, the NHS is not very good at doing cost-benefit analysis. It needs to get smarter at it, because the point that my hon. Friend makes is right, not only as regards the support we give to people with type 1 diabetes, but about the cost to the NHS of dealing with the consequences.

--- Later in debate ---

[Keith Vaz]

Indeed. Before anyone else jumps up with another name, I include all diabetics in what I am saying.

The Prime Minister and others such as myself talk about diabetes, and we are not cowering in corners; we are debating it openly. Because of technological advances, we are able to do our jobs and continue with our lives in a way that was not possible when diabetes was first discovered 100 years or so ago.

The first artificial pancreas, which was developed by Sir George Alberti through funding from Diabetes UK, was the size of a filing cabinet. Madam Deputy Speaker, can you imagine walking around with an artificial pancreas of that size? We should always acknowledge the research and innovation of which my right hon. Friend the Member for Knowsley spoke and the power of science to change people’s lives.

I want to give a few examples from my own city of Leicester of the work that has been done on diabetes. There is the work done by Professor Kamlesh Khunti and Melanie Davies of the University of Leicester; my own general practitioner, Professor Azhar Farooqi, who diagnosed me with diabetes—had I not been diagnosed, I might not be standing here today, because I did not know what the symptoms were—and Professor Joan Taylor from De Montfort University, who began developing her own version of the artificial pancreas.

It was very interesting to learn from my right hon. Friend’s speech about all the other clever people—probably much cleverer than all of us here—who have been able to develop their own artificial pancreas. Not all of them will be able to fly, so to speak, but it is amazing that people are putting their minds to it, and Professor Joan Taylor at De Montfort has done the same. There is also Professor Hovorka of Cambridge University who, like George Alberti, was funded by Diabetes UK in developing the artificial pancreas. These people deserve our respect and admiration for what they do, because they spend day after day trying to make the medical breakthrough that will help people and save so many lives. I want to thank them for what they have done, because their work has enabled us to get to the position we are in today.

There are also the private companies. Members do of course criticise, as we are entitled to do, the profits made by drugs companies. The Minister will know because she has to sign the cheques—perhaps she does not sign the cheques, but she sends them to the Treasury to get them signed—when the bills come through for the artificial pancreases and the metformins or Glucophages and all the other things that we take. The cost has gone up and there is no doubt that the drugs companies do make very big profits, but they should be commended for putting back so much of their profits into research and development. That is something that the Government cannot do, but it is something that those companies do every single day.

In acknowledging the huge cost of drugs, we also have to acknowledge what companies such as Novo Nordisk do. I declare an interest in relation to Novo Nordisk, because it has worked with the all-party group on diabetes, which I chair, for a number of years. Roche Diabetes Care is another such company, and there are many more. There are so many of them that I cannot name them all, but they have all been involved, and they will all invest and research until the breakthrough comes.

We know from FreeStyle Libre what Abbott has done. I remember the former Prime Minister—it is of course based in David Cameron’s old constituency—telling me five years ago about Abbott and the work it was doing on FreeStyle Libre. Now, thanks to the decision of Ministers, FreeStyle Libre is available, as my right hon. Friend the Member for Knowsley has said. That is why, when we have that breakthrough, it is vital that such a facility and such equipment is available to all, irrespective of where they live.

We did not have access to FreeStyle Libre in Leicester, even though we have so many experts at Leicester University and De Montfort, until the decision taken by the Government. Actually, we will not get access to it until next April, so my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) and others will have constituents who still want to get FreeStyle Libre, but cannot do so. We do not want that to happen for those who need pumps and artificial pancreases, because it is vital that they get such equipment straightaway. If they do not, it will affect their lives.

What my right hon. Friend the Member for Knowsley said about wellbeing or mental health and diabetes was interesting. That is something that people very rarely recognise, and I have only myself recognised it, having been a sufferer, in for the past two years or so. They do not actually know it because they think it is part of their condition. For type 1 diabetics, it is even worse. We can just have our pills—I take six in the morning and three at night; some people take more—but the fact is that they live with the injection of insulin for this condition for the rest of their lives.

The deputy leader of the Labour party, my hon. Friend the Member for West Bromwich East (Tom Watson)—obviously, he is not in his place today, because he has other things to do—has reversed his type 2 diabetes. Anyone who sees him in the Division Lobbies will know that he looks a completely different man from the person I knew when I voted for him to be the deputy leader, because he has adopted the Pioppi diet and changed his lifestyle. He does all the things that I do not, because I do not manage my diabetes particularly well. However, people cannot do that with type 1—it is with them forever. The right hon. Member for Hemel Hempstead (Sir Mike Penning), who obviously has gone to Committee Room 14, mentioned that there is that fundamental difference. Sometimes when we talk about the thousands —or the millions, now—who have type 2 diabetes as opposed to type 1, we talk about people changing their lifestyle, their diet or their wellbeing, but that does not apply to the type 1s.

[Sandy Martin]

Does my right hon. Friend believe that it would help an awful lot of people with type 1 diabetes if we changed the name of the disease, given that it is completely different from type 2?

[Keith Vaz]

Of course. There is the possibility of doing that—as we do with cancer, for example, which is a much more emotive illness. Of course, people can die from diabetes complications. My mother died from diabetes complications. What I am noticing from the correspondence that I get as chair of the all-party group is that people are writing to say that their relatives have died of diabetes complications and that clinicians are now putting that on death certificates and, in some cases, voiding insurance. I had a very interesting meeting with an insurance company recently that wanted to void the insurance of a particular individual because they had not notified it that they had type 2 diabetes. I asked its chief executive, “If you cross a road and you are knocked down by a car, and you have type 2 diabetes but didn’t know it and had not notified the company, would you still have your insurance voided?” and he said, “Yes,” which is outrageous. The implications are huge. This is a wide area, Madam Deputy Speaker, and I do not want to try your patience by talking about the whole, global aspects of diabetes. We could be here all night. Forget about the 7 o’clock Adjournment motion—we would be here forever, but actually, we need to be specific about type 1.

In answer to the question from my hon. Friend the Member for Ipswich (Sandy Martin), perhaps there is a case for doing what he suggested, because “type 1” and “type 2” are still very technical, whereas with cancer, there is the type of cancer that someone is suffering from. People may not understand that, so it is worth exploring, and we could certainly do that at the all-party group. The vice-chair, my hon. Friend the Member for Heywood and Middleton, is here—we will be able to look at it—and my right hon. Friend the Member for Knowsley is a frequent visitor. Let us see what we can do about it in future.

I want to end with three asks of the Minister through the good offices of my right hon. Friend. We have talked about CCGs, but we do not have the capacity in CCGs for diabetes champions. We still do not know how many specialist diabetic nurses there are in regions or even in constituencies. The hon. Member for Gosport (Caroline Dinenage) is a Health Minister, so I am sure that everyone will jump about when she goes back to her constituency, but if she asks the question, “Do we have a list of specialist diabetic nurses?” the answer is no. Do we have a list of those doctors such as David Unwin and others who are doing incredible work on diabetes—even if that work is not shared elsewhere? The answer is no.

In answers to parliamentary questions, I have a list of “don’t knows” coming back from Ministers. That is no criticism of the Minister—it is just that Ministers do not know. They do not keep that information centrally. My right hon. Friend the Member for Knowsley and I, as former Ministers, know that we had to sign PQs like that, too, when we just did not have the answers, because the information is not kept centrally. However, some of this information should be—there should be information about who the specialist nurses are—so could we get the CCGs together in some way to talk to them about the issues raised by my right hon. Friend, because lives are time-limited if they do not have access to the equipment that he is talking about?

The second issue is that the Government must be prepared to make a commitment, although not to providing additional funding, because the NHS is stretched. Where private sector companies, such as Roche and others, are investing and doing research that will benefit the public, is there any way to assist them by providing them with greater capacity to research, whether through encouragement, incentives or some other means? We need to do that because we do not have the money to do the research ourselves.

The third issue concerns personnel in the Department. I was astonished to learn that the Secretary of State had still not met the diabetes tsar, Professor Jonathan Valabhji. I tabled a question asking when he last met him, and it turned out he had never met the very expert appointed by the Government to assist in these matters. He is an outstanding diabetes tsar—probably the best the country has ever had—a frequent visitor to our meetings and a professor at St Mary’s, but he has not met the Secretary of State. Please will the Minister talk to her colleagues and ask that one of them meet with Professor Valabhji? It would be helpful if it was the Secretary of State, though, and would be of some assistance to him.

My final point concerns that made by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley. Diabetics such as myself—the same applies to type 1 diabetics—have to see nine different professionals, but we see them on different days, at different times and in different places. When we have our bloods done, there should be someone to help us with structured education, which is vital—we should not be made to book another appointment for another day when perhaps we cannot make it; there should be someone to check our eyes, too; and all this at the same time.

In Leicester, we are developing the first diabetes village, where a patient can do the lot on a Saturday morning—all eight of the main functions, including wellbeing, mental health and lifestyle. If someone with type 2 diabetes goes to the doctor in Doha and gets a prescription, before they get their medication, they are sent to a gym to make sure they make the necessary lifestyle changes before their medication kicks in. They have medical centres there with the panoply of services diabetics need.

Tomorrow, we will be holding an international diabetes summit in Committee Room 14, if it is vacated in time. In that respect, my message to Conservative Members is: get on with it, as the Prime Minister would say, and finish it off tonight—I do not have a vote in that election—so that we can have Committee Room 14 back. The Diabetes Minister, the hon. Member for Winchester (Steve Brine), and people from China, Denmark and Italy, are coming to share their experiences, and type 1 diabetes will be high on the agenda. The more of these meetings we hold in this place, the better it is to keep diabetes on the agenda.

Once again, I thank my right hon. Friend for securing this debate and for making sure we talk about these issues, and I thank my hon. Friend the Member for Heywood and Middleton, too, for her last debate on diabetes. We should keep putting in for these debates to make sure this is the highest possible priority for the Government.

Oral Answers to Questions

Sandy Martin Excerpts

Tuesday 27th November 2018 Commons Chamber

[Stephen Hammond]

The hon. Lady is right that the number of trusts that currently use the levy is not as high as it should be. We hope that all will do so. It continues to be a priority for us to broaden the routes into nursing. We will address in the long-term plan the specific matter about which the hon. Lady talks.

[Sandy Martin (Ipswich) (Lab)]

13. What estimate he has made of the level of workforce vacancies in the NHS.

[The Minister for Health (Stephen Hammond)]

The NHS employs more staff now than at any other time in its 70-year history. It has recruited 18,200 more doctors and 11,000 more nurses are in our wards since 2010. NHS Improvement publishes vacancy rates using provider information. As the hon. Gentleman will know, the record investment that the Government are providing will ensure that the number of vacancies reduces.

[Sandy Martin]

With Suffolk’s only psychiatric intensive care unit having been closed down from April to October this year because of lack of staff, and with a two-to-three-month waiting list for counselling, does the Minister not understand that his reassurances do not bear much relationship to people’s lived experience?

[Stephen Hammond]

I am aware that the local trust has had a number of problems and that there were a number of bed closures—both temporary and permanent —earlier this year. The trust is closely monitoring how those closures are affecting services and patients. The hon. Gentleman will know that beds are being reopened—five beds have been reopened recently—and that there is a plan to put in place the staffing so that the whole ward can reopen in the near future.

Nursing: Higher Education Investment

Sandy Martin Excerpts

Wednesday 21st November 2018 Westminster Hall

[Sandy Martin (Ipswich) (Lab)]

Does my hon. Friend agree that the important point is that the nursing course demands full-time study? Someone cannot do a part-time job while they are taking a nursing course. Unfortunately, because of the lack of maintenance grant, in most other areas of higher education students have to do part-time jobs in order to keep themselves alive, but it is not an option for nurses.

[Janet Daby]

I absolutely agree with my hon. Friend and I will address that crucial issue.

What I need to know, and what student nurses, potential student nurses and England need to know, is this: when will we see the long-term plan to promote the sustainability of the NHS and when will the Government take it seriously? I ask because the number of applicants from England aged 18 decreased by 12% between 2016 and 2018, while the number of applications from those aged 25 and above from England fell by 40% in the same period. Furthermore, a decline in the number of mature students affects specialist areas of nursing such as learning disability and mental health.

In all areas of nursing, not having enough nurses means that the safety of care is a concern—it could become fundamentally unsafe. Frontline staff are compromised, and people seeking to access health and care services are not able to receive the quality of care that they need.

Nursing students spend 50% of their time in clinical practice and—as mentioned by my hon. Friend the Member for Ipswich (Sandy Martin)—nursing courses run longer than many other degrees, which means that nursing students have no opportunity to take on part-time work to supplement their income. They deserve support that recognises the exceptional nature of nursing and we need to invest in their future. If we do that, we would also be investing in our NHS and, indeed, in England.

It is clear that student nurses work long hours, which demands much from them. This can be physically, mentally and in many cases emotionally draining. It is particularly difficult when a student nurse witnesses, for example, a newborn baby dying on a paediatric ward, or when they are caring for terminally ill patients or those with complex mental health needs. If the Government consider that training and the NHS worthy of recognition, when will they properly invest in student nursing careers?

I have been lobbied considerably. My local hospital is overstretched for health and care professionals, including for doctors and nurses. It seeks to recruit from overseas but, in the context of Brexit, the growth of the domestic workforce will be ever more important. The Government and NHS England must invest at least £1 billion a year in nursing, through higher education, as part of their long-term plan for the NHS in England.

Finally, I endorse and praise the work of the “Fund Our Future” campaign and I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this debate.

Organ Donation (Deemed Consent) Bill

Sandy Martin Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Friday 26th October 2018 Commons Chamber

[Matt Warman (Boston and Skegness) (Con)]

I begin, as I suspect many will, by paying tribute not only to the hon. Member for Barnsley Central (Dan Jarvis), but of course to all those he mentioned who have played such an incredibly important role in bringing this Bill so close to, and I hope by the end of the day on to, the statute book. This is a piece of legislation whose time has come, because we live in a society that is less religious than ever before and we are ever more aware of what good medical science can do. It is of course vital that we respect the wishes of those who do not want their organs to be donated, but it is also vital that we have a conversation about the good that organ donation can do. I particularly agree with the hon. Gentleman’s central point that this is not a panacea or a silver bullet. It is a surprisingly small part of the conversation that we need to have, now more than ever, about what organ donation can mean for the people who need those organs so much.

As my right hon. Friend the Member for Putney (Justine Greening) said, it is right that we are beginning to have this conversation in schools, and it needs to be surprisingly detailed. Many people whose consent will now be presumed will not realise that their presumed consent applies not only to internal organs but to corneas, for example, and to other parts of the body. Some people will find that genuinely invasive, even though the donation of those parts would do a huge amount of good. This is one of the many reasons why this Bill’s time has come.

People who wish to opt out must have a conversation with their doctor and with their family, so that when the time comes, the information that they have opted out is known, understood and easily accessible. I was hugely envious of the progress that has been made on this in Wales. It is inevitable that the family of someone who went on to give their organs and make a huge a difference would be profoundly unhappy if it later came to light that the person had expressed a wish, which had not been discovered, that their organs should not be donated. This is an immensely complex area, and the Bill provides as many opportunities as possible to opt out in a sensible and informed way. We also need to ensure that, if those opportunities are taken, they are known about and understood, because time is often of the essence when it comes to taking organs and ensuring that they do all the good that they can.

There will be a huge burden on the Human Tissue Authority to ensure that this works as well as it possibly can, because it will be the regulator for this scheme. This is a challenge that we have not faced before, and I know that the HTA is confident of the good that it can do, but we should be careful not to put doctors in the difficult position of being asked to take advantage of the legislation. There will now, I hope, be deemed consent, but it will ultimately be down to the doctors to make the call on whether to proceed.

[Sandy Martin (Ipswich) (Lab)]

Does the hon. Gentleman agree that one way to ensure that there are not misunderstandings is for everyone who is concerned about organ donation to discuss it with their nearest and dearest so that they all know that the person is happy to have their organs donated?

[Matt Warman]

I absolutely agree with the hon. Gentleman. This is all part of the broader conversation that we need to have. None of us wants to be in this position. We would all like everyone to have signed up to the organ donation register because they had already had that conversation. Given that we are where we are, however, the more people who have those conversations, the better.

There will be an increased burden on doctors as a result of this provision, not in workload but in decision making. If they have not been able to locate evidence of an opt-out, they will still have to be sufficiently content that they may take those organs that will be so important to others. We should be careful that the presumption of consent is not interpreted as a compulsion on a doctor to take organs. Of course doctors will not behave rashly; we know that they will be considered, cautious and sensible, not only because of the regulatory regime but because they would never seek to upset either the deceased or their family and friends in this situation.

I should like to conclude where I began, by saying that these are immensely complex matters and that this is not a panacea. It should be the beginning of a conversation to make more and more people aware of the huge good they can do, whether by donating corneas or kidneys. Such donations can now make a profound difference to multiple people, and even in moments of extreme sadness, families and friends can do a small amount of good. This Bill enables not only those individual operations, but hopefully a far broader conversation that will allow us to say that great good can be done and that presuming consent is the right balance and that, in the context of that broader conversation, we can ensure that people do opt out where necessary.

I commend this Bill and commend the bravery that some have shown in getting it through the House, because there is sensible and legitimate opposition to some aspects of it. I hope that the Bill will mark a serious bit of progress and will make the difference that everyone here hopes will be made to so many lives. In collaboration with the regulators and the medical profession, I hope that we can strike the right balance to get the maximum benefit and do not inadvertently cause pain and distress to people who are placed in a position that they would never wish to be in.

Transforming Care Programme

Sandy Martin Excerpts

Thursday 5th July 2018 Commons Chamber

[Norman Lamb]

I totally agree. It is, as I said at the start, sobering. In a way, all of us who strongly support the NHS must not laud it as a perfect institution with nothing to complain about. As far as this group of people are concerned, they have been very badly let down. Fundamentally, in many cases they have died early through neglect. That is intolerable in this day and age.

The nine principles, which are positive and empowering, are really good. I sign up to them completely. It is the implementation that is lacking and has largely failed. I say to the Minister that she is very fortunate to be in her wonderful job. My great frustration is that this programme came early in my time as Minister, but I learned, as I did the job, just how critically important implementation is. You think that by establishing good principles and getting everyone to agree to implement them those organisations will do what they have committed to do. It was probably naïve to think that. The reality was that nothing changed and it still has not changed. One critically important lesson to learn from that failure is to have a total, obsessive focus on implementation and national leadership.

[Sandy Martin (Ipswich) (Lab)]

Does the right hon. Gentleman agree that to achieve transformation in care, investment needs to be put into alternatives in the community before it is possible to free vulnerable people from these institutions, and that far too often, the public sector tries to make savings before it has made the investment in the things that will achieve the same?

[Norman Lamb]

The hon. Gentleman makes a really important point, and I totally agree. I said at the start that this is not a great demand for a whole load more money. However, some up-front investment is needed, not only in establishing the facilities in the community, but in training people in the community, and I will come back to that in a little while.

--- Later in debate ---

[Dame Cheryl Gillan]

Yes, it is very important that we look at what arrangements the devolved countries make for people with autism. Certainly a few years ago, Wales was well in advance with its plans for autism, which I found most commendable, but I think it now needs to revisit and update its plans, because none of these plans must be left to one side; they need to be constantly reviewed and updated.

I am pleased that next year we will have the opportunity to conduct a 10-year review of the Autism Act. I hope the right hon. Gentleman will contribute to the work that many Members are doing on both sides of the House in various areas, from education to employment, healthcare and even the over-representation of people with autism in the criminal justice system, so that we can put down a marker for the Government after 10 years on what progress has been made and how much further we have to go. If the hon. Member for Strangford (Jim Shannon) would be good enough to send me a link to the plans in Northern Ireland, or point me in the right direction, I am sure they will be taken into consideration as we carry out the review.

I am pleased to see the Minister in her place, as she obviously has a lead role, but I think that all relevant Departments need to play their part. I still have a feeling that we need a cross-departmental ministerial taskforce to cover the areas that I have just been highlighting, such as health, education, housing, and justice, all of which we will include in the APPG’s summary and presentation to the Government next year. Let me put down a marker for the Government. I want to know what plans the Minister has for the future of transforming care, whether she will establish that cross-departmental taskforce to lead the process, and what steps she will take to reduce the number of admissions of autistic people and improve the community services that should support them.

I work closely with many autism charities, and in particular with the National Autistic Society. Alongside Mencap and the Challenging Behaviour Foundation, it has been leading research on the experience of families who have been affected by the transforming care programme. It wanted to look into exactly how relatives came to be in mental health hospitals, and what was getting in the way of their being discharged back into the community. I commend to the Minister the report “Transforming Care: our stories”. It contains the very powerful stories of 13 families, and I think that she will find it very useful, if she or her officials have not yet been able to read it.

The report found that, despite the existence of a national programme, five areas needed real focus to make the programme successful. The first is

“Making sure the right services are available in the community”.

I think we have covered that. The second is involving and listening to individual families, and helping them to be heard through advocacy if necessary. The third is improving the quality of in-patient care. The fourth is

“Making plans for discharge and sticking to them”.

The fifth is providing specialist support from trained and understanding staff. For me, that last one is key. When we have met someone with autism, we have met just one person with autism. Everyone is different. Staff really need to understand that, and to be trained to understand people with autism.

[Sandy Martin]

Does the right hon. Lady agree that one of the most important aspects of support for the families of children and young people with autism is the availability of respite care, to enable them to cope with the very great additional duties that they have?

[Dame Cheryl Gillan]

Absolutely. I know from my constituency casework—as, I think, will every MP—that providing a safe home and a safe environment for a family member who has autism can be a very intense, demanding and challenging process, and respite care plays an important part in giving family members a breathing space.

The report includes some remarks from someone called Anna, the mother of Catherine, who is autistic and has a learning disability and obsessive-compulsive disorder.

“Anna told us, ‘she’s not getting any treatment, it’s just a holding pen because staff [in the unit] don’t have the right skills, expertise or mindset…Everything is about seclusion, never about trying to prevent incidents happening in the first place.”

That demonstrates to me that there is a lack of training, and that much more emphasis should be put on that.

The report goes on to outline recommendations made from people and organisations at every level, from individual professionals to NHS England and the Government. In particular, it suggests that a cultural shift is needed to ensure that individuals and their families are listened to in a way that can reduce the number of adversarial relationships that sometimes arise. The importance of a good understanding of both autism and learning disabilities, as a comorbidity, should be emphasised more than it is at present.

One of the parents of an autistic man with mental health problems said:

““Stephen just falls between the gaps and no one takes ultimate responsibility for his case… Where is the pressure to get Stephen back into the community?”

That is a cry for help from a father who wants to see his son go out into the community and have the quality of life that everyone deserves to be able to achieve.

The report also highlights a lack of accountability throughout the system, particularly when it comes to meeting the needs of autistic people. At a national level, in NHS England, leadership for autism falls into the gap between established learning disability and mental health teams. The appointment of a new strategy lead for autism in NHS England is considered to be a very positive step, but I need to be reassured that, in the future, NHS England will focus on the needs of autistic people in order to meet the Government’s requirement for a reduction in their health inequality, which is a commitment in the NHS mandate. I hope that the Minister will tell us what steps she will take to ensure that NHS England allocates appropriate resources to the needs of autistic people, and to ensure that the issues set out in “Transforming Care: our stories”—I am going to give her a copy—are addressed.

Autism charities regularly hear that autistic people struggle to find mental health support that meets their needs, and in the worst cases, if this is not available, people hit crisis and are admitted to hospital. Traditional mental health interventions might need changing, for example by using clear, non-metaphorical language or communicating with someone who does not speak. That, again, requires a good understanding of autism.

In 2016 NHS England published its mental health “Five Year Forward View” outlining how it plans to improve mental health services in England. It includes a number of proposals for new care pathways to help people access the right support and, importantly, it proposes a care pathway for autism. Work on designing this pathway is due to start this year, but I have not seen any detail on what it will include. It is vital that it covers the following for children, young people and adults on the autism spectrum: timely access to autism diagnosis, autism training for all mental health staff, and the ability to make reasonable adjustments for mental health treatments so that if autistic people need mental health support, they can get the right help from services. I hope that the Minister will also address how the autism care pathway will be developed and that it will cover diagnosis, access to tailored mental health support and autism training.

Another contributory factor to the number of autistic people in mental health hospitals is the inclusion of autism in the Mental Health Act 1983 definition of mental disorder, meaning that autistic people can be sectioned without a diagnosed mental health problem. The independent review of the Mental Health Act is very important and has been welcomed by the autism charities. They believe it is important to create a legal regime around mental health support that properly meets the needs of autistic people and their families. The status quo fails to do this, and that has resulted in autistic people being inappropriately detained under the Act and far too often subjected to damaging over-medication. The NHS digital data show that autistic people are not benefiting entirely from the NHS England transforming care programme, because the in-patient numbers are failing to meaningfully reduce and in some cases are rising. The review’s interim report has identified this definition of autism as a mental disorder as a key question to be addressed in the final report, and I strongly urge that the review must address the inequality for autistic people at the heart of the Mental Health Act. I hope the Minister addresses that in her closing remarks.

I have spoken for some time, and I hope I have added to the debate initiated by the right hon. Member for North Norfolk, although I appreciate that I have, inevitably, repeated some of the points he made. In conclusion, I go back to something I said earlier about the transforming care programme that I think summarises the situation. Put simply, if transforming care does not work for autistic people, it will not work. We want transforming care to work; we want it to succeed. It has made a start: it is not an all-good start, but it is not an all-bad start. The Minister and the Government have a golden opportunity to turn what is a visionary programme into something that can reflect the success of the care with which we look after people in our community with learning disabilities and autism. I look forward to hearing the Minister’s response.

Mental Health Services (Norfolk and Suffolk)

Sandy Martin Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I thank you, Madam Deputy Speaker, and Mr Speaker for granting this debate on mental health services in Norfolk and Suffolk and the challenges they face.

Quite rightly, the Government have talked a lot over the last few years about parity of esteem between mental and physical health and about the need to invest more in mental health services. Indeed, there has been limited extra investment in Norfolk and Suffolk. None the less, the NHS trust has faced challenges that are affecting the quality of patient care. Tonight is a good opportunity to bring before the House some of those issues and, hopefully, to offer some solutions and appeal to the Government to do more to help the trust in very difficult times, because ultimately it is the patients who suffer when trusts are in difficult circumstances.

First, I would like to pay tribute to Gary Page, who is the chair of the Norfolk and Suffolk mental health trust. Despite very challenging circumstances, difficult Care Quality Commission reports and the financial pressures that have faced services in Norfolk and Suffolk for many years, he has worked hard to make sure that there has been continuity. It is thanks to his leadership that the trust is now able to move forward and address some of the challenges that it faces with the quality of care.

I want to talk briefly about some of the issues involved, focusing mainly on ward closures and the points raised in the CQC report. I want to outline to the House some of the fundamental issues with staff shortages, which are probably the worst in almost any mental health trust in the country. I want to talk a little further about the finances of the trust, and I also want to talk about some of the difficulties there have been in how the trust works with addiction services and how that is counterproductive to the effective care and treatment of patients.

Although my medical work is not currently in the east of England, I want to draw attention to my declaration in the Register of Members’ Financial Interests. I am a practising NHS doctor working in mental health services, which of course gives me some insight into the challenges faced by the trust, although I do not think that interest is particularly applicable in this case, because my medical work is not done in the region.

The quality of care challenges facing the trust are quite extensive. As the Minister will be aware, the trust was put into special measures in October 2017. There are significant pressures on beds within local services, resulting in higher numbers of out-of-area placements for patients. Many patients are now having to be transported out of area to be treated because of the closure of beds, which is not good medical practice. It is not good for patients either, because they will be a long way away from their support networks, and it interferes with the effective post-hospital care and rehabilitation that is so important in co-ordinating with community services.

The challenges appear to centre on patient flow into beds and delays to discharge. We know that there is a historical lack of community mental health services in Norfolk and Suffolk, and investment has not been available to increase them at the necessary speed and rate. There are challenges with housing providers in the area not necessarily working closely enough with the trust, and there are also the pressures on social services that we know too well exist across the country. Those pressures are very relevant in Norfolk and Suffolk, where we have a lot of older patients with dementia who are struggling to be discharged effectively into the community because of delays in receiving adequate social services. A lot of the blame for that has been attributed to the mental health trust, but many factors are beyond its control.

The trust also faces significant challenges with the quality of its buildings infrastructure. Many of its buildings are old and not fit for purpose. The capital budget has not been available to improve the buildings, although there has been some new building work. I will come on to that in a moment.

[Sandy Martin (Ipswich) (Lab)]

My meetings over the past three weeks with the new chief executive and others have given me cause to hope that the structural problems are now being addressed. A new co-produced community services partnership, commissioned by the clinical commissioning groups and involving Norfolk and Suffolk NHS Foundation Trust, Ipswich and West Suffolk hospitals, the county council and the GP federation, is embarking on a level of integration that has never been tried before in the United Kingdom, working with district councils, schools and the voluntary sector to make mental health everyone’s business. Does the hon. Gentleman agree that the Government have a real interest in seeing whether that model can succeed? Will he support me in calling on the Minister to provide sufficient pilot funding for the project, so that Norfolk and Suffolk NHS Foundation Trust can recruit the staff it needs to make the new model capable of success?

[Dr Poulter]

I thank my constituency neighbour for that intervention. I entirely agree with everything he says, although I am not sure it is quite so pioneering—I think the hospitals in London would probably disagree with that. There is a lot of good work going on in London built around exactly that sort of model of more integrated care.

One of the challenges faced by the trust in the past, and which mental health trusts in general face, is the failure of many partner organisations to properly engage on issues such as the provision of adequate social care for patients with chronic and long-term mental illness and dementia. There is also the failure of housing providers to be involved and of the police to be properly involved. There is a big overlap between some people with mental ill health and presentation to the police, when they would be better looked after by the NHS.

This project is the right way forward, with more integration of services and better integration between mental and physical health. Many patients with chronic mental health needs have physical health problems. They are sometimes a side-effect of the drugs, but are often a result of a chaotic lifestyle. Better joined-up working with the local NHS undoubtedly has to be a good thing. For that to be effective, however, as we have seen in some pilot projects in London, there needs to be the funding to deliver it. The mental health trust is not in the best financial shape—I will come on to that later—and support from the Government through funding for this innovative way of working, which I think is certainly a first in a rural area, would be very welcome. I hope the Minister may be able to provide some reassurance on that this evening.

Leaving the EU: NHS

Sandy Martin Excerpts

Thursday 22nd March 2018 Westminster Hall

[Andy Slaughter (Hammersmith) (Lab)]

Thank you for calling me relatively early in the debate, Mr Stringer. I apologise to hon. Members, particularly those on the Front Bench, because I will not be here for the closing speeches, but I will of course read them assiduously. I and some other MPs have a meeting with Imperial Healthcare Trust that has taken a long time to arrange. Given the pressures and crisis of funding in many parts of the NHS, I think I need to be there. It is not entirely irrelevant to the subject of the debate. I will, for the reasons I have given, try to be brief and confine my comments to the issues that affect my constituents.

I am extraordinarily privileged to have some of the finest healthcare and medical research facilities not only in this country, but across Europe and the world, in Hammersmith and Shepherd’s Bush. I have three of the five hospitals in Imperial Healthcare Trust: Queen Charlotte’s and Chelsea, Hammersmith, and Charing Cross. I also have, being built as we speak on a 23-acre site in White City, the major new campus for Imperial College. They are amazing institutions that this country is proud to have, and they are truly international in the staff who work there, their research and co-operation, and the funding that they receive. We cannot avoid the fact that they are grievously affected by the consequences of Brexit. They are resilient organisations and they will do what they can to mitigate the effects.

Just a few weeks ago, Imperial College announced a joint venture with the National Centre for Scientific Research, one of the major French scientific research institutions. There is already a lot of international co-operation, but one of the main purposes of the joint venture is to allow continued access to vital European funding. We welcome attempts to mitigate the effects of Brexit, but when we talk about Brexit it always seems to be about how we can achieve a second-best position. Like my right hon. Friend the Member for Exeter (Mr Bradshaw), who eloquently expressed the variety of damage that Brexit will do to the healthcare sector, I find it difficult to see any positives. Yes, it is possible to see mitigation, but very difficult to see how we are going to be any better off in any capacity as a result of Brexit.

[Sandy Martin (Ipswich) (Lab)]

Does my hon. Friend agree that, given the research facilities he has described in the hospitals in his constituency, we are talking about not only the effect on the institutions, but the ability of the entire health sector to produce the best outcomes for patients in this country, because they get new treatments faster because of the co-operative work being done internationally?

[Andy Slaughter]

Yes, the system is fully integrated across EU countries, and the whole is greater than the sum of its parts.

Last November, the president of Imperial College, Alice Gast, revealed that some of the 2,000 staff at Imperial College who are EU nationals have already left. I will come on to why that should be the case, given what the Government have said on EU nationals. Half of them—1,000 people—have taken legal advice on their positions post Brexit. A quarter of the staff and a fifth of the students at Imperial are from the EU. In the healthcare sector across London there are 20,000 staff from the EU, which is about 15%.

A good example is another of my local hospitals, the Royal Brompton, where 30% of the clinical staff are EU nationals. I have visited the Royal Brompton, and it has the most extraordinary paediatric cardiac surgery unit doing the most advanced and delicate operations on newly born babies. When I visited, all the surgeons who were operating were EU nationals, I think from five different countries. The Government may say, “Well, so what?”, but I do not imagine that they maintain, as has been said previously, that we can give a sudden opportunity to replace many doctors and nurses with home-grown doctors and nurses. That is not going to happen overnight. We know that the demand is such that we will continue to rely on clinicians from abroad for the indefinite future.

Eating Disorders Awareness Week

Sandy Martin Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar]

The hon. Lady is absolutely right. It is always true in any situation that someone who has been there can speak with much more power and in a much more compelling way than someone who has not, however empathetic they are. The reality is that the recognition of an eating disorder for what it is—an illness—and getting the help and treatment for it is, all too often, still too slow. With an eating disorder, as with illnesses generally, the earlier an intervention and treatment take place, the easier it is to treat and the better the outcome for the patient.

[Sandy Martin (Ipswich) (Lab)]

Does the hon. Gentleman agree that mental health services require the ability to provide advice and counselling, especially to younger people, and that in many cases that is lacking?

[Edward Argar]

The hon. Gentleman makes a very important point. Mental health services, whether they are statutory mental health services or supported services from the voluntary sector, have to be able to address the needs of the individual as an individual. I will come shortly to funding and the provision of those services.

Beat’s report last year found that the average cycle of relapse and recovery could be six years, and that it took an average of three and a half years, or 176 weeks, between someone getting an eating disorder and their getting the treatment that they need. That average of 176 weeks goes across people who are under 19 and adults. For those under 19, the average is 130 weeks, and for those over 19, the average is 256 weeks.

Those statistics are worth unpicking a little. It is important to be clear that 91 of the 176 weeks come before an individual or those around them recognise that they have an eating disorder, and a further 58 weeks come after that point, before they seek professional help. Increasing awareness of the symptoms of eating disorders is vital. As a recent YouGov survey found, 79% of the people who were surveyed could not list a single psychological symptom of eating disorders, and 34% were unable to name any correct sign or symptom. Alongside that, however, it takes real bravery for someone to admit to themselves that they need help. It is incredibly hard for someone to talk about an eating disorder.

Diabetes

Sandy Martin Excerpts

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

The information and education courses are really important in helping to manage the condition. I will come on to talk about that very subject later in my speech.

To go back to the role of specialists, I know from my involvement with the all-party group on diabetes that the role of the diabetes specialist nurse is valued by many. Evidence shows that diabetes specialist nurses are cost-effective, improve clinical outcomes and reduce the length of stay in hospital. With rising numbers of diagnoses of diabetes, I ask the Minister to encourage employers to respond to this with appropriate workforce planning.

The third point from the survey is that people want better access to technology and treatments. Diabetes treatment is ever evolving and advancing, but 28% of those who took part in the survey reported problems in getting the medication or equipment they needed to manage their diabetes. The Minister may recall that last year the Prime Minister was seen at an event wearing a FreeStyle Libre glucose monitoring device, which has already been mentioned. It is this type of non-invasive device that makes life so much easier and more manageable for those living with diabetes, and it is a great example of the technological advances taking place today. This device is designed to liberate patients from the hassles of routine finger prick testing. However, so far, only one third of CCGs and health boards have placed FreeStyle Libre on the formulary, demonstrating the problem faced by many in obtaining access to new technology.

The fourth point is that there is also a need for education and information to be widely available. No one should be given a diagnosis of diabetes without also being informed of where to go for information and support. People’s ability to self-manage is essential for the successful management of diabetes. Self-management reduces the risk of complications and demand on health and care services.

[Sandy Martin (Ipswich) (Lab)]

Does my hon. Friend agree that children with type 1 diabetes require particular understanding from the teachers in their school if they are to stay safe, and a proper dispensation to eat when they need to eat and to do blood tests when they need to do so? Will she join me in urging the Department for Education to make the guidance to schools on type 1 diabetes more prescriptive?

[Liz McInnes]

My hon. Friend makes an excellent point. It is actually the fifth point of the survey—support and understanding at work and school—and I will go on to talk about that. He explained the whole point very well, and I totally agree with him.

To go back to the education programmes, the National Institute for Health and Care Excellence recommends that people should be offered a course around the time of diagnosis of type 2 diabetes, and six to 12 months after diagnosis for people with type 1 diabetes, with annual reinforcement and review. The Care Quality Commission survey found that, in general, people who had attended structured education courses were very positive about their experiences. The majority of people said that it was helpful in improving their knowledge and ability to self-manage. People identified benefits, including improved understanding and knowledge about their condition; improved self-control and management, such as diet and exercise; and the opportunity to discuss concerns and share information with other people. However, there was a clear theme of people saying that, although the courses were helpful, they wanted more opportunities to attend refresher sessions.

The fifth point is that people living with diabetes want more support and understanding at work and school. Good care at school is vital and all schools should have an effective care plan in place. For those in work, an understanding and informed employer can make the difference between that person being able to continue in productive work, and being forced to leave because of difficulties in managing their condition while at work.

Finally and most importantly of all, people living with diabetes want hope for the future. Once diagnosed, people live with diabetes for the rest of their lives. They want to know what is being done to work towards a world where diabetes can be prevented and cured. It is for that reason that I asked for this debate—so that we can discuss research, funding, awareness, treatment, support, information and education for those living with diabetes.