Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Sarah Olney Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Dr Griffiths, do you want to add to that?

Dr Griffiths: This issue highlights a fundamental flaw with the Bill, which is the nonsensical division between a terminal illness and what constitutes being a disabled person. Section 6 of the Equality Act 2010 states that a disabled person is somebody who has a “physical or mental impairment” and the impairment

“has a substantial and long-term adverse effect”

on their

“ability to carry out…day-to-day activities.”

If you have a terminal illness, it is likely that you will be defined within the terms of what is outlined in section 6, so it is a fundamental flaw, because disabled people will be incorporated within this.

The issue also highlights this arbitrary nonsense about a six-month perspective. What constitutes six months left to live, particularly if you are engaging with technological devices, medical assistance and so on? For example, I have a progressive condition that continuously makes me weaker and has respiratory complications and so on. If I remove the ventilator that I use at night, if I remove my other medical devices and if I stop my engagement with therapeutic services, does that constitute me having a terminal illness, because my rapid acceleration towards death becomes more evident?

These concerns highlight fundamental flaws, but they also play into what a key issue: the campaigning that will continue after the Bill, if it is to succeed. You will get people who will say, “Why not five months, or seven? Why not other conditions that are not being highlighted in our current discourses?”

[Sarah Olney (Richmond Park) (LD)]

Q Dr Griffiths, do you think it is possible that disabled people are likely to be or potentially more at risk of being coerced or otherwise persuaded to seek assisted dying as a result of the Bill?

Dr Griffiths: I think so—I think the coercion principles outlined in the Bill are incredibly weak in terms of the scrutinising and the process of how you judge whether coercion has taken place. We know that coercion is a complex issue, but put that against the context of disabled people’s lives; we are talking about disabled people who are struggling day to day to access sufficient support and to live in participatory, accessible societies. The feeling, then, of societal coercion—the feeling that this is a tolerable idea—highlights my concerns about coercion.

It also plays into the issue of support and assistance to understand what your rights are, not just in terms of what we are talking about here but broader disabled people’s rights. There is a lack of advocacy services available to disabled people, and there is a lack of support for disabled people to have accessible information about their rights. If you feel that assisted dying is your only choice—as opposed to accessing support or calling out discriminatory practices in, say, access to social care and healthcare—that highlights, again, situations where coercion will manifest. The infrastructure to support people either to respond to coercion, or to understand that they do not have to be in that position in the first place, is non-existent.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

Q One of the things that we have heard from other countries that have assisted dying is that this is one of the strongest and most robust laws. I wonder whether Professor Shakespeare has any more views on how we could make the Bill even tighter, and provide support and further peace of mind to people who might be worried about it?

Professor Shakespeare: When I read the Bill, I thought that it did have many safeguards. It has, for example, five opportunities for a conversation with doctors or other supporters. That is a good safeguard. I think it makes a criminal offence of dishonesty, coercion or pressure, so that would scare off people. Miro is quite right—there are people who might put influence on somebody, but I hope that they would be covered under clause 26 as having committed an offence. That would scare people who may have a particular view against assisted dying.

How can we make it stronger? We could have more of an advocate for the person who is requesting assisted dying—somebody who will support them, within the law, to make that decision or to think about their decision. We are trying to make sure that everybody who is thinking that this is for them has the opportunity to talk about it and to think about it. The time and the conversations are all about that, but maybe an advocate also would be the person who is requesting this step, who is not a beneficiary in any way of that death, and they could be a neutral party to give advice. I am not sure. However, there is a lot here. There are five conversations. I am not surprised that people thought it was strong. I think it is a strong Bill.

There is scope for doctors and other medical practitioners to act on their conscience and to withdraw from this. Miro made a useful point, which is that we do not want any disabled person frightened of their doctor or worried that their doctor, who has been supporting somebody else to die, might do that with them. In conversation, Marie, we have talked about an assisted dying service as being a part of the NHS, but I wonder whether it might be specifically around this. I think that it is worth considering whether the average doctor is the person to whom a person should take a concern or a wish to die.

So this is about advocacy and maybe having a specific service for people who want to go down that route. However, I think it is a strong Bill as it stands.

Health and Social Care: Winter Update

Sarah Olney Excerpts

Wednesday 15th January 2025 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. May I, through her, thank health and care staff in her city for the work they are doing to get the people of Birmingham through this particularly challenging winter? What we really need to do to make our health and care system more effective and more sustainable is shift the centre of gravity out of hospital and into the community. We need better and faster access to diagnostics and treatment, as well as a bigger focus on prevention—primary prevention to keep us all healthy and active, and secondary prevention so that fewer people need to call on health services, and particularly emergency departments, which are stretched at this time of year.

[Sarah Olney (Richmond Park) (LD)]

I was pleased to hear what the Secretary of State said about vaccine roll-out, particularly of the RSV vaccine. I am even more pleased that my constituents in Richmond Park are diligent in taking up all vaccines, but they have been puzzled to find that the RSV vaccine is limited to those between 75 and 79 years of age. What plans are there are to extend the roll-out to those aged 80 and above?

[Wes Streeting]

I am grateful to the hon. Member for her question and for showing off her constituents’ uptake—that is exactly what we want. Perhaps ahead of next winter, we should launch a parliamentary competition: who can boost uptake most in their constituencies? We will think about the prize.

More seriously, I am always glad when the pressure is to expand access to vaccines—that is exactly the sort of pressure that we want. We follow advice from the Joint Committee on Vaccination and Immunisation. We will review the experience this winter, and the JCVI will review evidence and data this winter and make recommendations, which we will take into account.

Oral Answers to Questions

Sarah Olney Excerpts

Tuesday 19th November 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

The UK rare diseases framework aims to improve the lives of people living with all rare diseases. I am more than prepared to meet my hon. Friend to look at the adequacy of support available to people with Usher syndrome.

[Sarah Olney (Richmond Park) (LD)]

T8. Last Friday, I met GPs at the Fairhill medical practice in north Kingston in my constituency. They have told me that the increase in national insurance contributions will add £50,000 a year to their costs. Can the Secretary of State tell me whether GPs can expect to see an across-the-board cut in the NICs payable by GPs to help them manage to continue delivering services for families in the area?

[Wes Streeting]

We have not yet announced allocations for general practice for the year ahead, and we are taking into account all the pressures that general practice is under.

Government Policy on Health

Sarah Olney Excerpts

Monday 9th September 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat Front-Bench spokesperson, Sarah Olney.

[Sarah Olney (Richmond Park) (LD)]

The Liberal Democrats find it deeply ironic that the shadow Health Secretary has raised this question on the involvement of people with no formal appointment in the development of Government policy. Are they forgetting their record in government? Perhaps we should remind everyone that, under the Conservatives, it was their friends that benefited from large contracts to supply the Government during the covid pandemic. The result is that, just today, as the hon. Member for Eltham and Chislehurst (Clive Efford) has already highlighted, Transparency International UK has revealed multiple red flags in more than 130 covid contracts totalling over £15.3 billion. With the Conservatives out of power, we have the opportunity to clean up our politics, so will the Secretary of State update the House on whether the Prime Minister plans to appoint his own ethics adviser or whether Sir Laurie Magnus will remain in the post? Will the ethics adviser be empowered to initiate their own investigations and publish their own reports?

[Wes Streeting]

I am grateful to the hon. Member for her serious contribution. She is right to say that transparency matters. That is why meetings in my Department, and their attendees, will be published in the right and proper way on a quarterly basis.

It is also right to draw a distinction between those areas of business and meetings in the Department that are about generating ideas and policy discussion, and those that are about taking Government decisions. It is right that people from outside government come into the Department for Health and Social Care, or any Department, to lend their expertise and share their views, and it is right that Ministers make decisions absent of those outsiders. That is the distinction I would draw. The hon. Member raises a specific point about the Prime Minister’s ethics adviser. This is a Prime Minister who does take ethics seriously and will not behave in the way that his Conservative predecessors did. As for individuals, that is a decision for the Prime Minister, but I will ensure that the hon. Member gets a more fulsome reply.

Children’s Cancer Care: South-East

Sarah Olney Excerpts

Wednesday 13th March 2024 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher. Thank you very much for giving me time to speak; I will not detain hon. Members long.

I congratulate my constituency neighbour and hon. Friend the Member for Twickenham (Munira Wilson) on securing this important and extremely timely debate. As she has already highlighted, the Evelina is an excellent facility and I commend the incredible work its doctors do every day. I do, however, share her view that the weight of evidence shows that St George’s Hospital would be a better home for paediatric cancer care in south London and the surrounding counties. I had an excellent experience of in-patient paediatric care there when my daughter was in the Frederick Hewitt Ward for a short period last year. I can confirm that the paediatric care there is excellent, and I would like to say to the hon. Member for Mole Valley (Sir Paul Beresford) that I had no problems with parking any of the times I visited my daughter.

One of the less well-known but most dangerous side effects of cancer treatment is the extreme increase in patients’ susceptibility to bacterial and viral infections. While most children with cancer are able to overcome minor infections, the mortality rate from infection is three times higher in cancer patients than in the general public. Because of that risk, many children living with cancer cannot take public transport or even smaller private hire vehicles. In the most extreme cases, visitors and carers are expected to shield so that they do not bring a risk of infection. Travelling by car is the only option available to many of these young people and their families. As such, any plan to bring paediatric cancer treatment in south London and the surrounding counties under one roof must ensure that certain patients can access the hospital safely.

The point was driven home to me when one of my constituents contacted my office after her daughter was diagnosed with Hodgkin’s lymphoma. During the six months that her daughter received chemotherapy and radiotherapy at University College Hospital, they had to travel from Richmond to the hospital in Euston several times a week for her to receive treatment. Due to the very limited parking at the hospital, and the need to avoid public transport because of the risk of infection, the family were forced to hire taxis to make the journey. Each round trip cost the family close to £100. That is not a unique situation.

On average, the families of children with cancer have to spend £250 and travel 350 miles each month to get their specialist treatment. Three in four struggle to meet those costs, and one in 10 miss or delay their treatment because of the expense. St George’s Hospital has two visitor car parks, and it has presented a plan to create a series of dedicated parking spaces and drop-off zones for the families of children with cancer. [Interruption.]

[Paul Scully (Sutton and Cheam) (Con)]

rose—

--- Later in debate ---

[Sir Christopher Chope (in the Chair)]

I call Sarah Olney, a few minutes early.

[Sarah Olney]

Thank you, Sir Christopher. I was on the verge of taking an intervention.

[Paul Scully]

The hon. Lady was talking about transport. Yes, the Evelina has amazing facilities, and parents can stay in Ronald McDonald House just opposite. However, the point is that it is easier to get to Tooting by car none the less, especially for people coming from outside London. Patient transport to the Evelina from Brighton takes more time to get into London from the outskirts than from Brighton to the outskirts of London in the first place.

[Sarah Olney]

The hon. Gentleman is absolutely right.

[Sir Paul Beresford]

I suggest that my hon. Friend the Member for Sutton and Cheam (Paul Scully) gets a new “A to Z”; the journey is not that much more difficult.

[Sarah Olney]

I am grateful to the hon. Gentleman, but my personal experience is that it is a lot easier to get from anywhere in the surrounding counties to the outskirts of London than from the outskirts of London to central London.

As I was saying, the Evelina’s parking facilities are, in the hospital’s own words, “very limited”. Patients are advised that there is often a queue for parking, which of course can only add to the stress of parents trying to get their children into hospital for urgent treatment. Given that the Evelina sits in central London just over the river from here, I am concerned about its ability to significantly expand parking provision.

The Evelina also sits within the congestion charge zone, meaning that any family member who wishes to visit an in-patient will be charged between £15 and £17.50 every time they come to the hospital. I acknowledge that TfL will reimburse the cost to patients with compromised immune systems, for families visiting on a regular basis who are not covered by the exemption, the expense could become significant; there is also a significant additional administrative burden for those families.

Admission to hospital can be a terrifying prospect for a young person. Parents often take shifts, keeping their child company during an unimaginably difficult time. If each day they drive to and from the ward, they could end up paying more than £100 a week in congestion charges alone. The NHS was founded on the principle that everybody should have easy access to life-saving medical treatment, regardless of their economic circumstances. I believe that St George’s meets that criterion in a way that the Evelina simply cannot. Both are world-class hospitals and both teams provide an excellent standard of care, but St George’s offers both parents and children a solution that truly meets their needs.

Oral Answers to Questions

Sarah Olney Excerpts

Tuesday 11th July 2023 Commons Chamber

[Maria Caulfield]

Actually, under this Government, last year, the number of first-time buyers passed the 400,000 mark, which is the highest number in 19 years. I will not take any lectures from a former Labour Prime Minister because when Labour was in government it saddled the NHS with a £10 billion failed IT system that never saw the light of day, an £80 billion failed private finance initiative contract that NHS trusts are still paying for, and a GP contract that enabled opt-out at weekends and evenings, which patients still suffer from.

[Sarah Olney (Richmond Park) (LD)]

Today marks the three-year anniversary of the death of Tom Pirie, who tragically took his own life just days after being assessed as at low risk of doing so by his counsellor. Over the last few years, I have been working with Tom’s father Philip on his campaign to improve suicide risk assessment procedure, particularly in view of the upcoming 10-year suicide prevention strategy review. Will the Minister join me in paying tribute to Tom’s life and Philip’s excellent work in his memory by providing us with an update as to when we can expect the review to be published?

[Maria Caulfield]

I absolutely pay tribute to Tom and to his father. I reassure him that we have many campaigners. Only last week, we received the baton of hope at No. 10 from those campaigning to reduce the number of suicides in this country. We are working on the suicide prevention plan and hope to be able to publish it very soon.

Junior Doctors’ Strikes

Sarah Olney Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

I thank my hon. Friend for his question. Yes, the Department is working very closely with colleagues in NHS England and across the NHS to mitigate as best we can the impact of the junior doctors’ strike. He is right that we had meaningful and constructive talks with the staff council representing “Agenda for Change” staff. I am very pleased that, as a result of the constructive engagement we had, the NHS staff council was able to recommend that pay award to its members. He is right that that points to the constructive approach that we have taken. We stand ready to have that constructive engagement with junior doctors, recognising the real pressures that the profession has been under. We will mitigate as best we can, but, given the timing over the Easter period, obviously, there is a risk in terms of patient harm. We will do all we can to mitigate that.

[Sarah Olney (Richmond Park) (LD)]

The latest figures from January 2023 showed 7.21 million people waiting for NHS treatment. What impact does the Secretary of State think this strike will have on the extremely hard work that has been done across the NHS to reduce those waiting lists, and what plans does he have to address the impact that the strike will have on waiting lists, if he does not plan to take any action to avoid it?

[Steve Barclay]

I think we can see what sort of impact it will have from the previous strike, which was over three days and impacted 181,049 appointments. We can see there will be a significant impact. On mitigations, as part of our electives recovery plan, we are doing a range of things, including expanding community diagnostic hubs and the fast-tracking of surgical hubs. The NHS is responding brilliantly with things such as super Saturdays, where teams process higher volumes of treatments, particularly in certain areas. We have the Getting It Right First Time programme, led by Sir Jim Mackey and Professor Tim Briggs, which is looking at how we embed best practice. Having hit the first interim milestone of our recovery plan in the summer, the two-year wait, we are now focused on the 78-week wait target and working our way through that.

Infant Mental Health Awareness Week

Sarah Olney Excerpts

Thursday 16th June 2022 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I congratulate the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) not just on securing the debate but on her ongoing passionate advocacy for our youngest citizens. It is a mission I am always happy to support her in.

One of the things that awoke my interest in this area was during the covid lockdown; both the right hon. Lady and the hon. Member for Strangford (Jim Shannon) have spoken movingly about the impact that lockdown had on many families. I spoke to mums in my constituency who were having their first child in lockdown, with all those pressures on them, such as not having contact with their partner or their family during labour, or with informal or formal networks afterwards. I reflected on how different their experience was from mine over a decade ago, when I had my babies. My first impression was of the impact of that on maternal mental health—I was pleased to secure a debate on that topic in March 2021—but the issue of infant mental health is so closely linked to that. I am grateful to the right hon. Member for South Northamptonshire for her really detailed opening speech. We have the data and the evidence, and it very much underpins the anecdotal evidence from our own personal experiences and those of our constituents.

A number of great points have been made about how much the baby’s mental health is based on the quality of the parent-infant relationship, and how the parent’s responses shape how babies experience emotions, regulate their own emotions and express themselves. We have referred a great deal to the research, but 15% of children—more than four in an average classroom—will have developed a problematic relationship with their main caregiver as a result of unpredictable or hostile care. As we have already debated, that troubled start increases the risk of children having poorer social and emotional wellbeing across their lives, and the ongoing and lasting impact that that can have.

My constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson), talked about some of the gaps in services to support infant mental health. We really must focus on that. There are currently 42 specialised parent-infant relationship teams in the UK, which focus on strengthening and rebuilding those early relationships. That means that most babies live in an area without access to such a team. They are multidisciplinary teams led by mental health professionals with expertise in working with babies and families.

A key area of focus is working with families that have experienced intergenerational trauma. With the right care, the trauma experienced by parents does not have to inform their infant’s development. However, it is so important that specialised services are there to detect such instances and are equipped with the skills and funding to intervene and support families where needed.

I will briefly touch on the experience of dads, which has been raised on a couple of occasions. I recently visited my local maternal mental health crisis unit, and I was surprised to find that there is no systematic care given to dads who experience mental health problems when their partners are pregnant. It might get picked up if their partner is coming for care, but it very much flies under the radar. In particular, we know that domestic violence can often commence during pregnancy. I see that as a direct result, perhaps, of men’s struggles with mental health as they become fathers. I therefore think it is a matter of real urgency that we pick up the matter of dads’ mental health, particularly from the beginning of pregnancy.

It is also important that mental health professionals can spot the signs of poor mental health in our youngest children, who cannot express their emotions in the same way that older children are able to. The hon. Member for Strangford mentioned the reviews of some of the horrific cases of child death that have been carried out recently—I am thinking of Star Hobson and Arthur Labinjo-Hughes. I do not want to talk too much about them, for the same reasons as he did not. I just cannot—it is just too much. But I really hope that someone is looking at that and thinking about what could have been done to detect the signs of mental distress in those young people who could not express it for themselves. We must be training people for some of these crisis situations, so that they can pick up on the mental health of young people who have difficult, damaged or problematic relationships with their caregivers and do not know how to express themselves, but are at risk of real harm if that mental distress is not picked up on.

Whenever I get the opportunity, I like to highlight the importance of health visiting. That is something that I picked up when I spoke to the first-time mums during lockdown. For full disclosure, my own mother is a health visitor, so I have been raised to regard health visiting as a wonderful thing, but that has been my experience as well. The importance of health visitors is that they visit—or should visit—every new mother, and her family, in her home. For those mothers who are finding it hard to reach out, it is an invaluable service to have somebody coming to them and asking if they are okay. We really must continue to support it. On infant mental health in particular, health visitors are uniquely placed to identify concerns, spot issues in early relationship and attachment forming, and identify where infant mental health may be an issue.

Families should receive a minimum of five mandated reviews by a health visitor between pregnancy and age two and a half, but even before the pandemic, many children were not receiving those core contacts. Over the course of the pandemic, the number of missed contacts has increased further, despite the fact that many reviews were conducted online or over the phone. One thing I am really concerned about is that we must not allow telephone or Zoom visits to become the new normal, because we will miss out so much from not visiting mothers in their home. Evidence of domestic violence and, in particular, the subject we are discussing today—those attachment disorders—will not be so evident if health visitor visits move to some sort of digital contact.

In 2015, responsibility for health visiting was transferred to local authorities. Since then, it is estimated that 30% of the health visiting workforce has been lost, with further losses expected. As with many local services, there is something of a postcode lottery in the availability and quality of support. My team and I have spoken to health visitors in north Kingston—the team that supported me when my children were babies—and they reiterated that currently, their biggest challenge is workforce issues. Almost 25% of their current health visiting team is due to retire in the next few years, and they are struggling to find candidates for the vacant roles. They recently advertised a vacancy that received just one application, and that person then decided that they would not take the post.

Health visitors work in relatively small teams with large case loads; in north Kingston, there are about 600 cases for every health visitor. That is unsustainable, not least because it forces health visitors to focus their resources on the most at-risk families. As we know, these problems can occur in all kinds of families from all backgrounds and income groups, so it is really important that we push for health visiting to remain a universal service with home visits.

I will end by stressing the importance of face-to-face contact, and that the health visiting service needs support and investment in its workforce. More than anything, we want to join up the agencies, so that the Department of Health and Social Care is working closely with the local authorities to make sure that the right information is being passed between agencies. If health visitors pick up anything concerning, they must be able to speak immediately to the other agencies surrounding the family, so that we do not have to read too many more distressing case reports like those I mentioned. The £300 million Start for Life programme that has recently been announced is wonderful—it will be great—but there is no funding in it for health visiting services. The funding sits within the DHSC, which is separate from health visiting; again, joining that up would make a huge difference.

With fragmentation, there is a risk that things will fall through the gaps. The one thing that we have all said clearly today is that the consequences of allowing that to happen are too big, both for our individual children—all those future MPs who we are looking forward to welcoming to this place—and for our society as a whole. We want to do everything we can to give little babies and children in every corner of the United Kingdom—in every part of the country—the best possible start. That includes supporting their mental health from the earliest days.

[Mrs Sheryll Murray (in the Chair)]

I call the Scottish National party spokesperson, Dr Lisa Cameron.

Government Action on Suicide Prevention

Sarah Olney Excerpts

Wednesday 8th June 2022 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Bristol East (Kerry McCarthy) for securing this debate. I can see that the subject is really difficult for her to talk about and I thank her for sharing her experience. I was struck by what she said at the end about how it is the people left behind who take on the suffering. I have had a bit of an insight into what she talked about.

I have a constituent here today, Mr Philip Pirie, who I am glad has been able to join us; he is in the Public Gallery. Philip’s son Tom took his own life in July 2020. I have been working with Mr Pirie since then and talking to him about his experience of suicide and how it has impacted him and his wider family and Tom’s family and friends. Mr Pirie highlighted a particular issue in Tom’s experience, and I have been happy to work with him on a campaign. We have previously spoken to the Minister about it.

Tom was a schoolteacher. He loved to travel and spoke three languages. He was much loved by his friends and family. Subsequent to his death there was a memorial football match, which was held to commemorate him, between his former school and club teams. Tom did seek help for his mental health issues, and he spoke to a therapist just a day before he took his own life.

A troubling feature of Tom’s experience is that he was assessed by his counsellor, at that meeting the day before his death, as being at low risk of suicide. That is something that has caused Philip and the wider family a great deal of distress, because if Tom had not been deemed to be at low risk of suicide, more might have been done to save him. So Philip has taken up with me the issue of suicide risk assessments by counsellors and how they are being used. It is a big issue.

We heard from the hon. Member for Blaydon (Liz Twist) about the extent to which suicide is a public health issue. The thing that has struck me is that suicide is the most common cause of death among young people aged 20 to 34—that is how much of a risk it is to our young people. More than anything else, that is how they are losing their lives.

Of the 17 people who die by suicide every day in this country, five would have been in touch with mental health services. The hon. Member for Liverpool, Walton (Dan Carden) mentioned that that is not enough, because so many people do not seek help. Of the five who have been in touch with mental health services, four will have been assessed as at low or no risk, as we have seen Tom Pirie was. That raises questions as to how we assess suicide risk, and I would like the Minister to address that.

Mr Pirie and I have organised an open letter and had a wide range of signatories to it. These include Steve Mallen from the Zero Suicide Alliance, who has already been mentioned, Mind, Samaritans, Papyrus, General Sir Nick Carter—we were very privileged to have his engagement with us—and a cross-party selection of MPs. This is really about discussing the current suicide risk assessment procedure, because we think that it needs some serious and urgent attention. We think that the standardised risk assessment tools as they are currently being used are poor predictors of suicide, and national guidelines have determined that they should not be used for that purpose. There is widespread concern that risk assessment tools are being used ineffectively, and that it is leading to the outcomes that we have seen in the case of Tom Pirie and others. We think that suicide risk assessment tools have a positive predictive value of less than 5%, which potentially means that they are wrong more than 95% of the time.

In its “Self-harm and suicide in adults” report from July 2020—the month that Tom Pirie took his life—the Royal College of Psychiatrists stated that

“the current approach to risk assessment is fundamentally flawed.”

The Government published a suicide prevention strategy for England in 2012, and they have recently announced a review and issued a call for evidence. The National Suicide Prevention Advisory Group is preparing to issue its recommendations for the review of that strategy, and the letter asks that:

“The Secretary of State for Health and Social Care ensure that the new suicide prevention strategy includes a review of the use of suicide risk assessments in breach of current guidelines and to take appropriate steps to ensure that existing guidance around not using these tools to assess suicide risk be strictly followed by both the public and private health sectors.”

That is a really important point, because there is a lot of mental health support that happens outside the NHS. Informal and unqualified support can sometimes be provided, and it is really important that the public understand and can have faith in the kinds of people who are advertising their support services for mental health patients, and that there is guidance and regulation around what is available.

In 2007, the Department of Health published a document entitled, “Best Practice in Managing Risk”, which underpinned and gave approval to some suicide risk assessment procedures. That important document is relied on by a number of institutions, including the Care Quality Commission and the coroner service, but has not been updated since 2009. We would really like to see the Department of Health and Social Care commit to updating the document alongside the strategy review, to ensure that the best current guidance is available to mental health practitioners in all sectors, that there is appropriate use of suicide risk assessment tools, and that we do not see a repeat of the situation that happened to Tom Pirie, who was assessed as a low risk the very day before he took his own life. I learned, in speaking to Tom’s father Philip, that it gave Tom the sense that he was not being listened to, and that his concerns and troubles were not being taken seriously. Obviously we will never know, but that cannot have been a helpful indicator for him at that moment in his life.

I pay tribute to Philip, who has been incredibly brave, and I know this has been a very difficult time for him. I am here today to urge the Minister to take on board my asks around risk assessment tools, because it would be a great tribute not just to Tom, but to Philip and his wider family.

[Mr Peter Bone (in the Chair)]

It might be helpful to say that we have three Back Benchers trying to catch my eye. I have to start the wind-ups no later than 10.30 am, so each Member has six or seven minutes max.

Skin Conditions and Mental Health

Sarah Olney Excerpts

Tuesday 25th January 2022 Westminster Hall

[James Sunderland (Bracknell) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Gray. I want to talk about mental health support for those with skin conditions, which is something that is often forgotten about by health providers across the UK and beyond. That is surprising, because 60% of British people currently suffer or have suffered from skin conditions at some point in their life. Those figures are comparable with cancer—it is a much bigger problem than we recognise. Some 98% of skin disease patients currently report that their condition affects their emotional and psychological wellbeing, yet only 18% have received any form of psychological support. That is a dichotomy that I want to explore very briefly—notwithstanding my sore voice, for which I am very sorry.

A key reason why support for these conditions is so important is that recent studies have proven that there has been an increase in psychological distress, and in the last two years in particular. That applies in particular to adults over 18 and children aged between six and 16. For over-18-year-olds, there has been an increase of distress from 20.8% in 2019 to 24.4% in March 2021. That in my view is a reflection of the pandemic, from which we have all suffered.

A study of adults over 18 also found that 26.1% of respondents reported self-harm thoughts at least once between March 2020 and May 2021. That is a hidden danger that we must all be aware of. It is even worse for those who are a bit younger. Among children aged six to 16, 39.2% have experienced some kind of deterioration in mental health since 2017—no doubt as a result of schools being closed and the isolation we all suffered from during the pandemic. For me, this debate is about the hidden dangers of the pandemic and the mental health cost on individuals.

That is made worse as young people emerge from the pandemic and their hibernation. How do they look? How do they feel? How low or high is their confidence? What about not having been in the sun for the last couple of years for those living in high-rise blocks in London and inner cities? What about skin conditions, such as acne? What about not going to school at that key age as a teenager? What about the lack of confidence that comes from having a skin condition? I want to raise these questions today. We can easily acknowledge the problem, but the solution is much more difficult.

Having discussed mental health, I want to move on to dermatology. The number of eczema sufferers in the UK has been steadily rising for the last 10 years. It stands currently at 1.3 million people. Interestingly, eczema is diagnosed much earlier. In around 90% of cases, it is children below the age of five. Psoriasis is much more of a problem for people that are slightly older. The prevalence of psoriasis in the UK today is a similar figure, at about 1 million to 1.3 million people. I am very familiar with it myself. Psoriasis is a problem that can affect how people look, and it is just one of many skin conditions, as we heard earlier from my right hon. Friend the Member for Gainsborough (Sir Edward Leigh). It is part of the whole panoply of skin issues that affect people so badly.

So what can we do? I want to raise three key points with the Minister. We need to improve the support for all those with skin conditions. We need to focus on the link between dermatology and mental health. First, I want to call on the Government to review their spending on dermatology to enable clinics to provide specialist mental health support for children and young people who suffer from skin problems. As we heard earlier, that may break the link between skin issues and mental health, which people are increasingly suffering from.

Secondly, we should ensure that, whenever possible, face-to-face appointments are available to those who need them. That is really important. It is about human contact and touch. A Zoom call with a doctor is fine, if people can get an appointment, but it does not recognise the problem. The doctor cannot see it nor feel it. That, for me, is very important.

[Sarah Olney (Richmond Park) (LD)]

The hon. Gentleman is giving an excellent speech. I, too, pay tribute the right hon. Member for Gainsborough (Sir Edward Leigh). This is such an important issue. I have been contacted by a constituent of mine called Margaret who is a lifelong sufferer of psoriasis. To judge from his opening speech, I think that much of what she said in her email to me would be very familiar to the right hon. Member for Gainsborough. Does the hon. Member for Bracknell agree with me about the importance of first contact with the doctor and how important it is that sufferers of all kinds of skin conditions can feel confident about reaching out to their doctor? As the hon. Gentleman says, face-to-face contact is so important. I also want to emphasise to anyone, anywhere, who might be suffering from a skin condition that help is available and they should not hesitate to seek it.

[James Sunderland]

I thank the hon. Lady for her intervention; I could not agree more. The simple answer is that doctors cannot see anything on a Zoom call. Also, people need to be able to see a doctor to get a prescription. If someone has a skin condition, they cannot just go to the chemist to get a prescription. They have to get an appointment first in order to get the prescription, and that is where face-to-face appointments come into it.

My third point is that we need to increase the range of psychological support for all those who need it. That is part of the panoply of health support that we need. A 2014 study showed that 94% of the patients who had completed psychodermatology treatment reported reduced stress, 92% reported increased confidence, and 90% reported that their skin condition was better understood. Wow. Those figures are amazing, but if someone asks for that treatment at this point in time, it takes up to a year for a referral, which is worrying.

I want to commend the excellent services locally in my constituency. The Frimley integrated care system is one of the best in the country, if not the best. The treatment that I have had personally has been pretty good, notwithstanding the delay that we are all suffering form. Lastly, I ask the Minister to reinvest accordingly in this very important area so that young people and adults are not suffering.