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.

Health and Care Bill

Sarah Olney Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Paul Bristow]

My hon. Friend speaks with much experience and makes a powerful point. I think he would agree that that core admin function is not what he went into medicine to do. He went into medicine to treat patients. I am grateful that the Minister laid out some of the plans that the Government have to deal with this issue. It is right that we should be looking to the long term, and the 15-year framework for future workforce is to be welcomed, but there also needs to be a much more regular reporting mechanism attached to that to ensure that we as Members are informed, but more importantly the NHS is informed, about how that challenge is going. The integration between NHS England and Health Education England—aligning the delivery arm and the workforce capacity arm—is probably also the right thing to do.

I end with this point: the challenges around workforce will be addressed not only by employing and training more NHS staff, although that is crucial—that is why I have some sympathy for amendment 10—but by ensuring that we work more productively by asking clinicians to operate at the top of their licence. It is also about ensuring that the NHS works smarter. We have created organisations such as Getting It Right First Time and NICE and asked them to go away and do the hard work of coming up with the most cost-effective and efficient ways of delivering care. If we ask those organisations to come up with the pathways and the ways of doing these things, surely it is only right that the NHS then adopts them instead of sitting there and saying, “These things will not necessarily work here.” We ask experts to come up with the right way of performing procedures; I suggest we go ahead and adopt them.

[Sarah Olney (Richmond Park) (LD)]

I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.

People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.

The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.

Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.

Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.

Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.

I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.

I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.

[Mr Kevan Jones]

Does the hon. Lady agree that it is not just about levels of pay and uncertainty for those individuals, but ensuring that we nationally accredit the qualifications of those individuals and address the career paths that do not exist in those sectors at the moment?

[Sarah Olney]

The right hon. Gentleman is absolutely right, and that is the point I want to make: we need to boost the status of our care home staff and improve their terms and conditions. We need to improve their pay. This lady who I spoke to on Saturday was telling me that she gets paid for the hours she spends in people’s homes, but not the time spent travelling in between. It is clear to me that the crisis of staffing we are experiencing in our care sector—I think every one of us as MPs is hearing about it regularly from our constituents, who are at the sharp end of that—is as much about workforce planning and improving terms and conditions. The Government needs to give that the most urgent attention, and amendment 10 would go some way to resolving that, although it will not resolve it entirely.

I know that Ministers will push back against the cost of boosting the workforce in all areas of the NHS, but they must surely realise the cost of failing to do so. The right hon. Member for South West Surrey. along with the hon. Member for Central Ayrshire (Dr Whitford), spoke about the cost of locum resource in the NHS. It is not just about the direct cost of locums or of worsening health outcomes as people wait longer for treatment; it is also about the lost productivity of days off sick, the cost of poor mental health as lives are put on hold and, as has been mentioned many times, the cost of exhausted and demoralised staff who are overwhelmed by the demands on the NHS. We cannot afford to continue to fail to effectively plan our healthcare workforce.

I am also very happy to support the amendments tabled by the hon. Member for North West Durham (Mr Holden) on virginity testing and hymenoplasty. I am delighted that the Government are adopting the provisions on virginity testing. We still have much to do to make this country a safe place for women and girls, but all progress is to be welcomed, and I am very glad that this opportunity to bring to an end the degrading practice of virginity testing has not been lost. I congratulate the hon. Member for North West Durham on all the work he has done and, although they may have left the Chamber, the representatives of the other charities referred to earlier. I hope in due course we will see the provisions for hymenoplasty as well, when the review has concluded.

[Mr Deputy Speaker (Mr Nigel Evans)]

I have three people indicating that they wish to speak. I ask people to make really short contributions, because I want to give the Minister six minutes to wind up and we will then go into the votes at half past.

Giving Every Baby the Best Start in Life

Sarah Olney Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sarah Olney (Richmond Park) (LD)]

I beg to move,

That this House has considered the matter of giving every baby the best start in life.

I am grateful to the Backbench Business Committee for giving us time for the debate. Among all the turbulence created by the pandemic and the lockdown, I am pleased that we have the opportunity to debate at length the impact of those events on those who are likely to live with its after-effects the longest.

The building blocks for lifelong emotional and physical health are laid down in the period from conception to the age of two. Those first 1,001 days are a critical time for development, but they are also a time when babies are at their most vulnerable. Babies do not yet have the language skills to advocate for themselves, so carers and services must be equipped to do that on their behalf. During the first 1,001 days, babies are also uniquely susceptible to their environment. Chronic stress in early childhood, whether caused by maternal depression, poverty or ill health, has a negative impact on a baby’s development.

Early intervention and prevention to support the wellbeing of babies during this time is strongly linked to better outcomes in later life, including educational achievement, progress at work and mental health. Failing to invest in giving babies the best start in life delivers not only a human cost but an economic one. The total known cost of parental mental health problems per year’s births in the UK is estimated to stand at £8.1 billion.

[Chris Elmore (Ogmore) (Lab)]

I thank the hon. Lady for securing the debate on an issue that is close to my heart, having had a lockdown baby at the end of January—he is just over nine months now, and he is very happy and causing all sorts of chaos in my and his mother’s lives. The hon. Lady mentioned mental health, and my constituent Mark Williams has spent many years speaking publicly about the mental health issues he experienced after having his first child. It is extremely important that we wrap care around the mother and the baby after birth, but does the hon. Lady agree that we should also do more to allow fathers to get support with their mental health and to realise that becoming a father is a deeply profound thing and that there is nothing wrong with talking about our mental health as a father after having a child?

[Sarah Olney]

I congratulate the hon. Member on the birth of his baby, and I hope that all is progressing well. I am grateful to him for raising that point about fathers, and I will come to it later in my speech.

My interest in this topic arose from conversations I have had with constituents who gave birth during lockdown. They told me about the isolating experience of not being able to have their partners in the delivery room with them, not being able to share their new babies with the wider family and not being able to meet up with other new parents to support each other and share their experiences. Thinking back to my own experiences of early motherhood—12 years ago—I remember how much it meant to me to have all those people around me as I recovered from the birth and got used to my new life as a parent. My heart goes out to all those who struggled in isolation during those early months, and I am determined that young families should be prioritised for support as we emerge out of the other side of the pandemic.

The UK Government’s recent focus on investment in the first 1,001 days in their “Best Start for Life” vision and funding is very welcome and will undoubtedly make a significant difference to families. I pay tribute in particular to the efforts of the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), who has been unsparing in her work to bring the needs of our very youngest citizens to the forefront of public policy and funding.

One of the most important sources of support for new parents is a health visitor. Even for those who enjoyed the most robust mental health, having sudden responsibility for a tiny and vulnerable new baby who is entirely dependent on them is a source of great anxiety. Having a visit from a trained health care professional who can give them advice, answer their questions and, above all, reassure them is enormously helpful and can make all the difference to their early experience of parenthood.

Although the UK is no longer in lockdown, both access to services and working patterns have changed. Some support services, such as playgroups, have not survived, and some have closed altogether. Children’s centres have reopened, but numbers are limited and places need to be booked in advance, which may mean that the families with the least time on their hands will lose out. The co-ordinators and volunteers at Home-Start Richmond, Kingston & Hounslow have told me about the high levels of anxiety experienced by new mothers unable to access health visitor advice and reassurance. That is impacting new mothers’ confidence and their ability to meet their baby’s needs.

Health visitors are a skilled workforce of specialist public health nurses who have the expertise to provide holistic care to families. As the only professionals positioned to reach every young child before they start school, health visitors play a crucial role in child safety and early childhood development. They identify and manage developmental delay, as well as common and serious health problems. They also provide support around childhood immunisations and advice on infant feeding, safe sleeping and mental health, all of which relieves pressure on NHS emergency departments and specialist services.

However, there is currently no national plan to address falling health visiting workforce numbers. The Government's spending review stated that it

“maintains the Public Health Grant in real terms, enabling Local Authorities across the country to continue delivering frontline services like child health visits.”

In fact, the Government are maintaining the public health grant at a level that is too low for many local authorities to resource health visiting services that can deliver face-to-face visits and the support described in the healthy child programme and other national guidance.

Ahead of the spending review, 700 leading children’s sector organisations were united in their call for investment for 3,000 more health visitors over the next three years. However, I am concerned that £500 million over the next three years will not deliver the Government’s pledge to rebuild health visiting. It is of the most urgent importance that we restore face-to-face health visiting to every new mother as the most essential building block of support to families as they welcome their new babies.

The importance of early home visits by skilled healthcare professionals was highlighted to me by one constituent who wrote to me last summer. She said:

“My baby is now 6 months old and soon after birth he was diagnosed with SMA type 1. If you are not familiar with it, the full name is Spinal Muscular Atrophy and it’s a muscular wasting illness. There isn’t a cure for it and without treatments and proper care the life expectancy of a baby is less than 2 years. He is currently under treatment but, and here is the reason for this letter, every possible centre specialised in physiotherapy, hydrotherapy or other physical activities for disabled people is shut due to Covid-19.

My husband and I were the ones who had to notice something was not right with Peter because, due to Covid, no one came for home visits after birth to see the baby or me. I almost died in child birth and because we were left alone I had to endure 1 month bed ridden due to further complications, once again noticed by me. Only once I was able to walk again we saw something wasn’t right with the baby. If after 2 weeks the health visitor had been able to come home, my son would have started treatment sooner without losing the mobility of his legs.”

I want to talk a little more about the importance of diagnosing and treating perinatal mental health. Maternal suicide is the leading cause of direct deaths within a year of pregnancy. An estimated one in four women experience mental health problems in the first 1,001 days after pregnancy. While depression and anxiety are the most common perinatal mental health problems, other conditions include eating disorders, psychosis, bipolar disorder and schizophrenia. One in 10 fathers is also affected by perinatal mental health problems. Of the 241 families that Home-Start Richmond, Kingston & Hounslow supported during the most recent year, 66% were experiencing mental health difficulties, including post-natal depression, anxiety, depression and chronic mental health conditions.

I was privileged to be able to visit Springfield University Hospital in Tooting recently to meet the perinatal psychiatry team for the South West London and St George’s Mental Health NHS Trust. I was extremely pleased to hear about the work the trust is doing in successfully supporting new mothers who struggle with their mental health, and particularly that it was able to maintain its services during the lockdown and after. Akvinder Bola-Emerson, the clinical services lead for perinatal psychiatry, stressed in particular the need for peer support but also the importance of health visitors, whom she described as the “eyes and ears” of perinatal mental health services.

The visit highlighted for me that we also need better provision for new and expectant fathers. Currently only mothers can be formally diagnosed with a perinatal mental health problem. Springfield provides services for fathers, but it is currently able to identify mental health issues in fathers only when they accompany a mother who is attending the hospital for perinatal mental health issues.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

I am extremely grateful to the hon. Lady for securing the debate, and she is making some very important points. Does she agree that one of the worst situations expectant parents can find themselves in is when there is a miscarriage and that parental leave for such parents would be a welcome reform?

[Sarah Olney]

I am grateful to the hon. Member for his intervention. He is absolutely right that there are a large number of events and incidents surrounding pregnancy and birth—as I know from my own experience—that can cause huge distress, and it is right that mothers and the people supporting them, and fathers as well, get the support they need, including statutory leave from employment for the time it takes to come to terms with the miscarriage. That is certainly something we should be looking at.

We know that impending fatherhood can be a cause of great anxiety for men, and more services need to be developed to support them. We also know that over a third of domestic violence starts or gets worse when a woman is pregnant. I would speculate that some of that is attributable to undiagnosed and untreated mental health conditions in expectant fathers, which underlines the need to do more to support them.

In addition to health visiting and perinatal psychiatry, support for children and their families throughout their early years is vital for enhancing children’s prospects at school and beyond. Evidence shows that effective integration of services in the earliest years can bring broad benefits. For example, Sure Start children’s centres are shown to decisively reduce hospitalisations during childhood. However, 1,300 children’s centres have closed since 2010, and recent research has shown that 82% of parents of young children have struggled to access early years services. I am pleased that the Government have now committed £80 million to introducing family hubs to 75 local authorities across England, and £50 million for parenting programmes. However, we need more information on what family hubs can provide, and I would particularly like to ensure that health visiting and mental health support are included.

The importance of the right support in the early years was brought home to me after a recent meeting with primary headteachers in my constituency. I heard about how difficult it is for nursery and reception-age children to settle into class and to get used to spending time with other children and not spending all day at home with their parents. For adults, lockdown has been 18 months of inconvenience, after which we expect to be able to pick up the threads of our former life. However, some young children who started nursery this term will have spent up to a third of their life in lockdown, and we cannot yet know what the long-term impact will be.

[Wera Hobhouse (Bath) (LD)]

Is my hon. Friend alarmed, as I am, by the fact that domestic violence has increased during lockdown, which has particularly affected young or very young children? The Government need to look at the backlog of cases that have arisen through the lack of attention to domestic violence, or inability to look at it, during lockdown, as it did not really come to our attention.

[Sarah Olney]

My hon. Friend is absolutely right, and incidents of domestic violence during lockdown are a matter of grave concern. We know there is a clear link between domestic violence starting or worsening and a pregnancy in a family. That issue needs a huge amount of attention; more mental health support for both partners would help a great deal.

The lockdown will have increased disparities in educational outcomes between those from poorer backgrounds and their richer classmates, and I call on the Government to do more to provide catch-up funding to our schools, and allow them to spend it on a greater range of services. Local headteachers tell me that funding can be allocated only to academic tuition, and that they have identified many children, including the very youngest, who need mental and emotional support to help them in school.

I will conclude by saying thank you to everyone who has talked to me about their experiences in this area, but particularly our health visiting and perinatal mental health teams, who do so much good and valuable work for new families. I also acknowledge the huge contribution made by the voluntary sector in supporting new families, in particular the work of Home-Start, which provides an excellent network of support. It takes only a small amount of encouragement, a little word of advice or a sympathetic listening ear to give a new parent confidence, but it can make a world of difference to their children. A small investment in the beginning of life can reap huge rewards, not just for individual children and their families but for whole communities, and the right start can enhance not just individual educational achievement and wellbeing but reduce risky and antisocial behaviours. Few pounds could be better spent, or yield a more valuable return, than those invested in our youngest citizens.

--- Later in debate ---

[Sarah Olney]

Thank you, Madam Deputy Speaker. I thank all hon. Members who have spoken in our debate, which has been really interesting. I particularly thank the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) for all her work.

It was great to hear from the Minister about how much has already been delivered and the spending that has been announced. I thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for all her support in getting the debate together. She made some very interesting points about employment discrimination. I also want to pick up on what the hon. Member for Washington and Sunderland West (Mrs Hodgson) said about the importance of climate change.

The hon. Member for Penistone and Stocksbridge (Miriam Cates) made some very interesting comments about the economic impacts of motherhood. I was particularly struck by her comment that children are not an economic inconvenience; I agree 100%. I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for sharing his personal experience, which was really thought-provoking. I also thank my hon. Friend the Member for Bath (Wera Hobhouse) for mentioning trauma and adverse childhood experiences.

All hon. Members have added a really interesting dimension to the debate. I thank them all.

Question put and agreed to.

Resolved,

That this House has considered the matter of giving every baby the best start in life.

Oral Answers to Questions

Sarah Olney Excerpts

Tuesday 19th October 2021 Commons Chamber

[Gillian Keegan]

Yes, I completely agree. Some 95% of the jobs are with private providers, so it is important that they take care of their workforce. There is a lot of competition for labour and a lot of skills shortages in our country. Most workers are on just above the national living wage, but it worries me that a third are on zero-hours contracts, so there is a lot we can do to improve the terms and conditions of the social care workforce. My hon. Friend raises a good leadership example.

[Sarah Olney (Richmond Park) (LD)]

8. If he will make it his policy to keep prescriptions free for people aged over 60.

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

The Department’s consultation on aligning the age for free prescriptions with the state pension age closed on 3 September. The responses to the consultation are being reviewed, and we will outline the next steps in due course.

[Sarah Olney]

We know that low incomes are associated with worse healthcare outcomes and also that average prescription use is higher among those in more deprived areas. Will the Minister accept that increasing healthcare costs for those on low incomes will mean that health inequalities will widen, increasing the pressure on low-income families and the NHS this winter?

[Maria Caulfield]

I thank the hon. Lady for her question. I reassure her that around 90% of prescription items in the community are provided free of charge. Those who are vulnerable and on low incomes, such as those on universal credit, income support and jobseeker’s allowance, already qualify for free prescriptions. It is really important that those over the threshold can also apply for the prescription prepayment certificate, where all their items will cost just about £2 a week. We are making sure that costs are low for those on low incomes.

Covid Vaccine Passports

Sarah Olney Excerpts

Wednesday 8th September 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for my hon. Friend’s work. He has been a champion of the vaccination programme and I am grateful to Medicare Pharmacy. We continue to have pop-ups at universities and walk-ins around the country, and incentives to young people to get vaccinated. We also continue to redouble our efforts to keep the vaccine evergreen for those who have not yet had their first dose.

[Sarah Olney (Richmond Park) (LD)]

Last week, I spoke to a constituent who is a widow with four children and has been working for the NHS on the frontline throughout the pandemic. One of her children has a range of very complex needs that can only be met by full-time residential care, and there is only one setting in the entire country that can meet his particular needs. She has been told that it cannot take him because of a shortage of care staff, and that the particular difficulty in recruiting at the moment is the requirement for care staff to have had two jabs. As the right hon. Member for Forest of Dean (Mr Harper), who is no longer in his place, highlighted, the vaccine does not prevent infection or the spread of covid. So why, given the crisis in recruitment of care staff, do we still have this requirement for two jabs when it is not effective and is depriving vulnerable people of the care they need?