Children and Young People’s Mental Health

Debate between Wera Hobhouse and Nadine Dorries

Wednesday 16th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Twickenham (Munira Wilson) for bringing forward this important debate. We have had a number of interactions and I know how genuinely important the issue is to her. I am aware of the meeting she had with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). I will give some information, but also reassure her that we are continually working on these issues. More has happened as a result of her meeting. I know she is genuinely very concerned about this issue and has been since the day she arrived in Parliament.

As the Minister, I speak to all stakeholders, trusts, organisations and just about everyone involved in the area of mental health, particularly among children and young people. It is incredibly important that we keep our language and our comments about children and young people both proportionate and responsible. There is not a mental health pandemic. I will go on to explain what I mean by that.

It is very important that we divide wellbeing from mental illness, not least because we do not want mental illness to fall by the wayside in people’s awareness and understanding of mental health, because the conversation is dominated by mental health and an overarching title that is not appropriate. Mental health is divided—it is not just a catch-all title. We have people who suffer with serious mental illness and childhood mental illnesses, such as schizophrenia, psychosis and eating disorders. I congratulate the hon. Member for Bath (Wera Hobhouse) on her speech; we have discussed eating disorders many times, and she is compassionate and is compelled to improve eating disorder services for children and young people in the UK. I thank her for her commitment to the issue.

It is incorrect to describe 140,000 children as having been turned away. The measurement of progress against the five-year forward target is based on two contacts with NHS services—this is an important point. Many children and young people have one session. After that, it is jointly decided to close their referral. To quote the 140,000 figure is misleading. One session is thought enough to provide them with the help they need or, more importantly, to provide pathways to their carers, parents and those who accompany them to the appointment. The expansion of Every Mind Matters, which was developed by Public Health England, to include children and young people under the age of 18 has been a huge boost. It is wrong to say—to misquote—that 140,000 children have been turned away. It is important to look at the reasons why.

I began by saying that I speak to stakeholders, trusts and others. I would like to quote from a letter a trust sent to MPs, following a debate on the issue only days ago. The trust said: “Partner organisations work incredibly closely to ensure children and young people receive the services they need.” It was referring to the narrative used by parliamentarians. It said that frontline staff had worked tirelessly throughout the pandemic and had taken the additional investment that the Government had provided to increase their workforce, and that to describe their services as failing had an impact on the morale and wellbeing of dedicated frontline staff and those who are delivering services to children and young people. It went on to say that the statements that were being made caused concern and alarm to children and young people and their families at an anxious time.

We have a responsibility in Parliament when we are talking about mental health, particularly of children and young people, to keep language proportionate. For me, talking in a debate about children throwing themselves off a bridge is completely beyond the mark and I am afraid that I think that that type of language is exactly what the trust was referring to—[Interruption.] The hon. Member for Tooting (Dr Allin-Khan) is commenting from a sedentary position. I reiterate my comments, Sir Gary. It is important that we consider the families and the people that we are representing and do not make inflammatory statements.

I have heard first hand from NHS staff that thousands of children and young people have had to adapt to the challenges of covid-19. It has been an incredibly tough year for everybody, and many children and young people have felt anxiety, apprehension and a gamut of emotions that adults also felt when faced with the unknown, sudden and rapid change to routines as well as a lack of understanding of what would happen and how life was to continue. However, many people are resilient, and many of those children and young people, who at stages reported they felt all those emotions and were included in that statistic of one in six, came through once there was a greater understanding of what was happening and how it was going to work. They were incredibly resilient, and we should be proud of those children and how they helped others too.

We take the pandemic and the mental health of children and young people extremely seriously. I work seven days a week on what this Government do, what we provide and how we assist. Although I have been criticised by the hon. Member for Tooting for talking about the investment we provide, we cannot provide services without the money for them. We cannot increase our mental health workforce if we do not provide the money to train people and to provide those services and that is exactly what we have done. I have no shame in quoting the figure of £2.3 billion a year that is going into mental health services—more than any Government has ever ploughed in, plus an additional £500 million to a mental health recovery plan for the pandemic this year, of which £79 million has gone into eating disorder services based in the community. We hope that that funding will allow around 22,500 more children and young people to access community health services.

[Wera Hobhouse]

The Minister has quoted the numbers for what the Government have made available. As I said, unfortunately a lot of that money has not reached the frontline. Will she make CCGs accountable and that money goes where it is meant to?

[Ms Dorries]

It is a constant pressure for me to ensure that. NHS England has worked incredibly hard to establish community-based services. It is important to say that the uptick in eating disorders came before the pandemic—it was spotted before it struck. We can have another debate on why we were beginning to see that rise in eating disorders, and the hon. Member for Twickenham and I have had that discussion. I am proud of how the NHS has rapidly looked at how we can deal with this exponential rise in eating disorders, because that is where our problem is.

We know exactly who has been affected by the pandemic, in terms of mental health services. We know from the referrals that have gone to our partners across the board and to local services. I am saddened to say that eating disorders are our toughest problem at the moment because of the exponential rise—over 22% over the past year.

NHS England is using that money. As I said a moment ago, having the workforce to provide services is really important, so we have accelerated the number of mental health support teams that we are putting in. The first question I asked when I took up my ministerial post was: “Can we have more mental health support teams in schools faster? Can we accelerate the long-term plan so that we get more areas covered quicker?” It took the pandemic to make that happen, but now—I have not even used my speaking notes; I have gone completely off piste—I think we have another 112 school areas covered. I will write to Members attending today to give them the figures on mental health support teams. We have managed to accelerate the programme by over a year as a result of the £500 million of funding that we put in.

Something that we can really shout about is that we have people coming forward. Mental health was never an area where people really wanted to work. I remember during my nurse training that we were given the option to take 12 weeks’ maternity or 12 weeks’ mental health, and my entire cohort took 12 weeks’ maternity. Nobody went to do the mental health training. Now—the pandemic has highlighted this—we have 100 applications for every place in university for people to train in mental health. That means mental health support teams to go into schools, deal with eating disorders and work with children and young people. When we put that kind of money in, run those kinds of courses and have the commitment to accelerate mental health workers, we do not see those results overnight, but that work is being done now to ensure we have the results. We want to ensure that people come out of universities and go into mental health support teams in schools. I have seen the work they do and how they work with children and young people.

Time has whizzed on, and I would just like to make a few points. The hon. Member for Lewisham West and Penge (Ellie Reeves) spoke about young mums and infant mental health. I am totally with her. That is why I worked so hard during the lockdowns to ensure that we kept support groups open for mums and young babies, and particularly those that give mental health support to mums. That included all sorts of groups, such as playgroups—Monkey Music is one that somebody used—where mums could meet together with their young babies. I argued for that and made the case for supporting their mental health. During the pandemic, those groups were kept open for young mums because I felt it was so important that they were supported.

Black Maternal Healthcare and Mortality

Debate between Wera Hobhouse and Nadine Dorries

Monday 19th April 2021 Westminster Hall

[Ms Dorries]

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

[Wera Hobhouse]

Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?

[Ms Dorries]

That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.

We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.

This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.

We are not afraid of setting targets, however. Setting targets in maternity units is what we are about, to make them safer places in which to give birth and in order to reduce both neonatal and maternal mortality rates, but we need to do the research on the near misses, to understand what the problems are. We cannot set targets until we know what we are trying to achieve through those targets and what we need to address. Five X More has asked for that research to be done. It needs to be done, and it will be done.

We are committed to reducing inequalities and to improving outcomes for black women—we work at that daily. I established the maternity inequalities oversight forum to focus on inequalities so that we in Government understand what the problems are. The forum also brings together experts from across the UK—we have met MBRRACE-UK and Maternity Voices—who have done their own research and studied this problem, to hear their findings and recommendations. Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, is leading the work to understand why mortality rates are higher, to consider the evidence on reducing mortality rates, and to take action to improve the outcomes for mothers and their babies.

NHS England is working with a range of national partners, led by Jacqueline Dunkley-Bent and the national speciality adviser for obstetrics, to develop an equity strategy that will focus on black, Asian and mixed-race women and their babies, and on those living in the most deprived areas. The Cabinet Office Race Disparity Unit has also supported the Department of Health and Social Care in driving positive actions through a number of interventions on maternity mortality from an equalities perspective. The Royal College of Obstetricians and Gynaecologists has established—

Women’s Health Strategy

Debate between Wera Hobhouse and Nadine Dorries

Monday 8th March 2021 Commons Chamber

[Ms Dorries]

I would like to reassure my hon. Friend, and I hope that she will do her utmost to make sure that those women she is aware of are aware of the link and will provide us with their evidence. It is the evidence that we need to develop the women’s health strategy, so we need to hear from exactly the women she is talking about. Complex needs are just that: they are very complex. We need to know about these women’s experiences in the healthcare sector—what acts as a barrier to them, where they think they are not heard, where they think their voices are drowned out and where they feel they are not listened to and do not get the services they should get. I will use endometriosis as an example. It can take women seven to eight years to be diagnosed, all the time being told that they may have a mental health condition, that it is something they have to live with and that that level of pain is normal for a woman to experience, when none of those things is true. We want to hear from those women.

I thank my hon. Friend for her question, which is really important. She is right: many women suffer from a number of complex health issues and have difficult lives. That is why we have made responding so simple, via a link on a phone and taking a few minutes. I really hope that those women hear this call and will respond.

[Wera Hobhouse (Bath) (LD) [V]]

I welcome the Minister’s statement on the women’s health strategy. It has already been mentioned this afternoon but, as the chair of the eating disorder all-party parliamentary group, it needs emphasising again: eating disorders have the highest mortality rate of all mental health disorders. While eating disorders do not discriminate, they affect women disproportionately. The longer they go untreated, the longer and more complicated it is to recover. Will the Minister look at the evidence—there is already plenty of it—showing that we urgently need waiting time targets for adult eating disorder services?

[Ms Dorries]

I thank the hon. Lady for her question; I was waiting for it as I knew she would be contributing today. We have had private conversations about this issue, and I want to reassure her. I hope she noticed that some of the £79 million I announced last week will be going towards dealing with eating disorders and the recent surge in referrals to mental health services. She is right to say that there is lots of evidence, and we are aware of what happens with eating disorders and how they develop, and we work with charities, as she well knows. We would still like those women to respond to this call to evidence.

Many women struggle to get anyone to listen or understand that they have an eating disorder. We struggle to identify them early enough or pick up such things. We still need to gather that evidence, because it is at certain points of contact that healthcare professionals do not recognise or realise that they are dealing with an eating disorder. That is the kind of thing that we think we could get fresh evidence about from women by them clicking on the link and letting us know, either via their phone or their laptop. The hon. Lady has a huge number of contacts, so I urge her to inform them and ask them to contribute to the call for evidence.

Ockenden Review

Debate between Wera Hobhouse and Nadine Dorries

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

My right hon. Friend asked a number of questions that deserve answers, so please bear with me. His first point was about the number of caesarean sections and the thought or belief in the hospital that it was a good thing not to have them, which the report identifies.

The report shows us that there were years when C-sections at Shrewsbury and Telford were running at 11% and the national average was 24%, and at 13% when the national average was 26%. That demonstrates a lack of collegiate working between midwives, doctors and consultants. Most of the report’s recommendations show that, fundamentally, that is the problem: a lack of communication and an unwillingness to work with people—the medics, doctors, obstetricians and midwives. My right hon. Friend is absolutely right about intervention. There is the old saying, “Mother knows best”, but every woman should own her birth plan and be in control of what is happening to her during her delivery.

I give all thanks to my right hon. Friend, because this report is fundamental in terms of how it is going to inform maternity services across the UK going forward, not least because the NHS is working on an early warning surveillance system. What happened at Shrewsbury and Telford was that it was an outlying trust. As with East Kent and others, including Morecambe Bay, where we have seen issues, there has been an issue culturally; they are outlying, without the same churn of doctors, nurses, training or expertise. The NHS is now developing a system where we can pick up this data and know quickly where failings are happening.

Oxytocin is a drug used in the induction of labour to control the length, quality and frequency of uterine contractions. There are strict National Institute for Health and Care Excellence guidelines on the use of that drug. My right hon. Friend is correct: every trust should follow the guidelines. By highlighting that in this report, we will ensure that trusts are aware of those guidelines and that they are followed in future.

[Wera Hobhouse (Bath) (LD)]

Our heart goes out to all those who have suffered these tragic events and losses; those of us who are parents or grandparents suffer with these families. May I ask the hon. Lady a question as the Minister for Mental Health? The mental health of mothers during and after pregnancy is vital, not just in the tragic circumstance of baby loss or severe injuries during birth. Will she ensure that training in perinatal mental health becomes a strong focus for improving maternity services across the country?

[Ms Dorries]

I hope the hon. Lady will not mind my mentioning it, but I know that she is about to become a grandmother herself soon, so I understand the reason for her questioning. She raises a very important point. I know she is aware, because I believe we have had this conversation, that we are focusing on women in the Department at the moment, and of course the mental health of women is a big part of that. The post-natal depression services that have been rolled out across the UK in the past 18 months are a testament to the fact that we are focusing on mental health. I take her point on board, and she has made it before.