Gay Conversion Therapies

Wes Streeting Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

I am grateful to the hon. Gentleman for securing the debate and for all the work he does to champion LGBT equality. I am sure that many of us received the Core Issues Trust’s interesting briefing, which suggested a link between homosexuality and same-sex attraction and mental ill health and other forms of physical illness. Has it not got that the wrong way around? It is discrimination and the suggestion that there could be a gay cure that makes all LGBT people, and young people in particular, feel that they are different and somehow alien. That is what causes them mental ill health, not their homosexuality.

[Mike Freer]

The hon. Gentleman has a track record in this area even though he is new to the House and I am sure that he will be extremely vocal on these issues. He is absolutely right. It is the suggestion that homosexuality is a disease or illness that can be cured that drives mental health problems, not the other way around. Frankly, I wasted no time on reading the Core Issues briefing.

I will finish with a couple of comments from esteemed colleagues. On 29 April, in an interview with Pink News, the Prime Minister said, on banning such therapies,

“if we need to go further…we will.”

As far as I am concerned, we do need to go further. The Secretary of State for Education and Minister for Women and Equalities said a couple of weeks ago to Pink News:

“Let me be clear: gay cure therapies have no place in our countries and we must stamp them out.”

I ask my very good friend the Minister if she will agree to explore how stipulated aversion therapies can be banned and whether the voluntary memorandum of understanding should and can be reviewed to put it on a statutory footing.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for initiating this debate on this important issue. Let me start by wholeheartedly agreeing with his opening premise. The Government do not believe that being lesbian, gay or bisexual is an illness to be treated or cured. We are concerned, therefore, about the issue of so-called gay-to-straight conversion therapy and we have consistently spoken out against the need for that practice.

I will outline some of the background to the work my hon. Friend touched on and try to respond to some of his concerns, but I suspect that this is the beginning of an ongoing conversation—I am happy to say that at the outset. The UK Council for Psychotherapy first raised its concerns about the perceived increase in this type of therapy with the Department of Health in late 2013. Department officials met with the council to discuss those concerns and agreed to work with it and others to identify ways to eradicate the practice. At that time, we also welcomed the fact that the key professional counselling and psychotherapeutic bodies had already made public statements on the issue.

As a result of the UK Council for Psychotherapy’s approach, the Department agreed to support the publication of a statement that made clear that the major therapy bodies in the UK were united in speaking out against conversion therapy, because they believe that that particular approach is based on the assumption that homosexuality is a mental disorder or that it begins from the preconceived view that the client should change their sexual orientation. As homosexuality is not an illness, as my hon. Friend said, the professional bodies argue that it is both logically and ethically flawed to offer any kind of treatment. The House may be interested to know that the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders in 1973 and the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992.

A consensus statement was published in February 2014 as a result of the exercise we convened. It was initially signed by eight organisations and others added their support later on. The statement is clear: those bodies believe there is no good evidence that such therapy works and that, actually, it has great potential to cause harm. It goes on to say that such approaches are often based on religious interpretations of sexuality rather than on a researched and informed understanding of sexual orientation.

As my hon. Friend said, the Department agreed to host a roundtable event on 2 April 2014 to which we invited a range of interested organisations comprising signatories to the consensus statement as well as royal colleges, the Association of Christian Counsellors, regulators and other counselling bodies. The right hon. Member for North Norfolk (Norman Lamb), who was then the Minister responsible for equalities, was fully supportive of the work and attended and contributed.

I am pleased to say that the meeting was positive and that out of the discussions came agreement that more could and should be done by those present to prevent this kind of therapy from being offered. The participants agreed to develop the memorandum of understanding, which has been referred to. The UK Council for Psychotherapy agreed to lead on the work, in partnership with other bodies and the Department.

The memorandum was published in January and launched at a second roundtable event at the Department. Once again, my former colleague the right hon. Member for North Norfolk was present and publicly made clear his support for the memorandum and its commitments. Its purpose was to set out an agreed framework for activities for all the parties concerned to help address the issues raised by this practice. One such aim is to ensure that the public are well informed about the lack of evidence and the risks of so-called conversion therapy. There are a range of other important professional objectives.

Professionals from throughout the healthcare and psychological professions committed to work together to promote the public interest. Each of the signatory organisations committed to actions appropriate to their function and purpose. To give one example, those with practitioner members agreed to review their statements of ethical practice and consider whether there was a need to publish a specific ethical statement on conversion therapy. Secondly, those with a responsibility for training committed to work together to ensure that training prepares therapists sufficiently, so that they can work effectively with their lesbian, gay or bisexual clients.

The memorandum is owned by the organisations who signed it. They have continued to meet together and to work on those commitments throughout the year. The Department fully supports that work.

My hon. Friend drew attention to the NHS’s part in such therapies. Discussions with the sector uncovered the fact that there were no reliable, up-to-date figures on the use of conversion therapy. However, a 2009 survey of 1,300 mental health professionals found that more than 200 had tried to help at least one client to reduce the attraction they felt for someone of the same sex. A third of those clients were said to have been referred for therapy by a GP and 40% were reportedly treated in the NHS.

The Government are clear that moneys from the public purse should not be used to fund such therapy. Ministers in the previous Administration wrote to NHS England in March 2014 seeking confirmation that such treatment was not taking place on the NHS and I am pleased that we received a robust and supportive response from Simon Stevens. Not everyone in the House may be aware of his response, which was that

“so-called gay-to-straight conversion therapy is harmful nonsense and the NHS should never be funding it.”

[Wes Streeting]

Clearly, the memorandum has been effective since it was introduced, but it concerns me that the briefing from Stonewall suggests the Nursing & Midwifery Council, the Care Quality Commission, the General Medical Council and the Health and Care Professions Council are not yet signatories. Does the Minister agree that they should sign up? It has clearly been helpful for other organisations and is a powerful statement of intent.

[Jane Ellison]

The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.

Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.

Junior Doctors’ Contracts

Wes Streeting Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

My hon. Friend makes an important point. The junior doctors I have met are genuinely worried that the proposals make it more likely, not less, that they will be forced to work even more punishing hours. The removal of financial penalties for hospitals that force junior doctors to work beyond their rostered hours concerns them. They are right to be concerned.

[Wes Streeting (Ilford North) (Lab)]

A junior doctor in my constituency made precisely that point. She was an A&E doctor. My hon. Friend knows that there is an A&E crisis in London. The Health Secretary needs to understand that while there is indecision and no conclusion to the negotiations, junior doctors are making decisions about where they are going—and they are not staying in England. That is the point.

[Heidi Alexander]

I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.

NHS: Financial Performance

Wes Streeting Excerpts

Monday 12th October 2015 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The House of Commons Library estimates the cost to the NHS from falls this year at around £2.45 billion. At a round table that I chaired last week with our local NHS trust it was clear that although the will is there to tackle the cost of falls, the resources are not. Is that a good example of how the under-resourcing of the NHS is harming patient outcomes and undermining the efficiencies that the Minister hopes to achieve? How will he address that and wider inefficiency in the NHS?

[Ben Gummer]

I point the hon. Gentleman to parts of the country such as Torbay, Greenwich and the soon-to-be-devolved Greater Manchester authority where the relationship and integration between social care and hospitals is producing exactly the kind of linked up action that he identifies for falls. If we can achieve that at local level we will have a truly integrated health and social care system that is not imposed from above but created by those who deliver care on the front line.

NHS Reform

Wes Streeting Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I absolutely agree. I commend the Royal Derby, which is an excellent hospital, and thank my hon. Friend for mentioning it. It is really interesting: around the country the number of people per thousand who use A&E varies from 166 to 355—a dramatic variation—and a lot of that relates to the availability of good primary care services, which is why our plans for seven-day GP appointments are also a very important part of the programme.

[Wes Streeting (Ilford North) (Lab)]

I welcome the partnership on patient safety that is being announced today between Queen’s hospital in Romford and King George hospital in Ilford and the Virginia Mason Institute, and echo some of the comments made by my hon. Friends about the Government taking staff with them and looking at issues around pay and workforce. May I gently point out to the Secretary of State that it is now two months since I wrote to him about pressures in our local health economy and the future of our A&E department. Can he offset my disappointment by agreeing to meet me and my hon. Friend the Member for Ilford South (Mike Gapes) and other local MPs to discuss those issues?

[Mr Hunt]

I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.

Barking, Havering and Redbridge University Hospitals NHS Trust

Wes Streeting Excerpts

Wednesday 15th July 2015 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate and on opening it in the way he did, setting out the chequered history of the trust and the particular challenges we face right across our borough of Redbridge and the wider north-east London health economy.

I will not repeat the points made by my hon. Friend and my right hon. Friend the Member for Barking (Margaret Hodge). I want to express my concern about the outstanding problem that the CQC has identified with the trust and the impact that is having on patient care in a wide variety of areas. I share the concerns expressed by both my colleagues that the CQC inspectors rated the trust as “requires improvement” on most measures, and the responsiveness of service at the trust was deemed “inadequate”, but it is also important to highlight some of the areas that were identified as having outstanding practice—in particular, the values of the trust and how they have been embedded in the culture of the staff.

Like my colleagues, I congratulate the NHS staff who work in the trust on the hard work they do in difficult circumstances. I commend the fact that the radiotherapy unit was one of the top five in the country. There are good outcomes for stroke, and the genito-urinary medicine clinic had

“excellent service with appropriate protocols”.

Significant improvements have been made, so while it is disappointing that the trust remains in special measures, the improvements described in the report are encouraging and reflect well on the NHS staff and the reinvigoration of the trust leadership. They can take genuine pride in their teamwork. I have no doubt that the trust will emerge from special measures sooner rather than later.

My right hon. Friend spoke about the high level of agency spend. One of the problems that the trust has suffered from for a number of years—frankly, some of the trust’s challenges were well known before the inspectors put the trust into special measures—is that when a trust has a poor reputation, it is hard to recruit and retain the best staff. While I am disappointed that we are not yet out of the woods, I hope that when people are thinking about their careers, they identify not only that the trust requires improvement, but that it is improving and is a good place for good people to be at this point in its journey.

I want to speak briefly about the wider north-east London health economy. Until May, I was chair of the Redbridge health and wellbeing board, deputy leader of Redbridge Council and the cabinet member for health and wellbeing. It is fair to say that the challenges in the north-east London health economy—the challenge in primary care has already been touched on—are not just restricted to the trust. I was the first chair of the primary care transformation board, which is trying to change how primary care is delivered and bring about genuine service improvements. In the very first meeting, I asked GPs about their experiences, and they described primary care as being in crisis. They know that they are not providing a good enough service to their patients. They work hard to do so, but the pressures are immense. That relates to the quantity and quality of GP provision. My right hon. Friend talked about the wider concerns about the number of GPs who are past or nearing retirement and the workforce pipeline. Combined with the fact that Redbridge has one of the lowest levels of public health spending in London, that gives me cause for great concern. I am concerned not only about the level of public health funding but about the fact that the Government are seeking to give councils new responsibilities —for example, for health visiting—without sufficient funding. The in-year cut that my council will experience will place even greater pressure on services. On that note, I should probably declare that I am still a member of Redbridge Council, albeit an unpaid one.

Finally, I want to talk about A&E. Since January, there have been some improvements in A&E performance at both King George and Queen’s. In January, King George’s performance standard was 92.67% and at Queen’s it was 79.15%. As of June, King George had improved, up to 96.56%, but Queen’s was still lagging behind at 93.31%. I have seen absolutely nothing in either the CQC’s inspection report or the performance data for our local A&E departments to alter my view that the loss of the A&E department at King George hospital would be a disaster for patients.

Since the decision to close the A&E department at King George, much has changed in terms of both the population pressures and the immense strain on the whole health economy in our part of London, which I have already described. In that context, it is really not unreasonable to ask Ministers to intervene, to look at the A&E closure with a fresh pair of eyes, and to ask the clinical commissioning group to reopen the A&E closure decision and reconsider its position. Previously—this always happens at the height of elections, particularly local elections—my local Conservative association put out a statement claiming that there had been some sort of reprieve and the A&E would not be closing, but nothing of the sort has happened. Thousands of residents across Redbridge will never forgive the Conservatives if they do not at least look at this matter with a fresh pair of eyes.

We all heard what my right hon. Friend the Member for Barking said about the financial issues at the trust. There is absolutely no doubt in my mind that those issues and the difficulties in recruiting staff across two A&E departments are what are really driving the closure of King George’s A&E. It is being driven not by what is in the best interests of patients or what good A&E configuration in our part of London would look like, but by the inability to get the right staff and to rescue the trust from its very difficult and precarious financial position. That is not good enough. I hope that, when he responds, the Minister will at least assure residents that the Government will look at this matter with a fresh pair of eyes and ask the CCG to do the same.

A&E Services

Wes Streeting Excerpts

Wednesday 24th June 2015 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

I hope, Madam Deputy Speaker, that you and the House will indulge me if I spend my six minutes giving an update on the “Shaping a healthier future” programme, which afflicts west and north-west London. I have done so several times during the three years since—to the consternation and disbelief of 2 million people in those areas—the programme was announced, although there was something of a hiatus over the election period.

I do not want to be self-indulgent, but I think that the subject of “Shaping a healthier future” is one to which all Members will wish to pay attention, because it is the biggest closure programme in the history of the NHS. Four out of nine A&E departments and two major hospitals have been substantially downgraded. Many see the programme as a prototype for the Keogh review of urgent and emergency care. I wonder what has happened to the latest stage of that review; we heard nothing about it from the Under-Secretary of State. It was put on ice last year because a proposal for the downgrading of most of the type 1 A&E departments in the country was seen as political suicide, but it now seems to have disappeared completely. I hope that there are good clinical reasons for that.

Reference has already been made to the excellent briefing with which Members were provided yesterday by the Royal College of Emergency Medicine. Here are three of the statistics that the college came up with. The increase in A&E attendances last year was equivalent to the workload of seven large A&E departments; only 2% of A&E attendances involve major trauma, stroke and heart attack patients; and a maximum of 15% of patients who attend A&E departments could be seen in a non-hospital setting. Even that must be subject to a caveat, because I suspect that a fair number of the people who go to A&E departments are not knowingly accelerating their symptoms or time-wasting, but have genuine concerns, perhaps for a child with a fever that might be a symptom of flu but, again, might be due to meningitis.

The solution proposed by the Royal College of Emergency Medicine is co-location. Its briefing states:

“Costly and time-consuming efforts to encourage patients to seek advice on urgent care by telephone or to attend elsewhere…have not reduced A&E attendances. Rather than blaming patients for attending A&E, when we know they have great difficulty accessing supposed alternatives, RCEM advocates a completely new approach. We believe that the issue should be dealt with by collocating”.

However, many hospitals in west London are already co-located, so that cannot be a solution for them.

There have been a number of developments in the past three or four months. Chelsea and Westminster hospital is about to take over West Middlesex University hospital. That new trust will believe that it can maintain two fully functioning type 1 A&E departments—unless another is to close in the area. Why, then, is Imperial College Healthcare NHS Trust expected to manage with only one major A&E service in its three hospitals?

Ealing hospital’s maternity unit will close on 1 July. My hon. Friend the Member for Ealing, Southall (Mr Sharma), who could not stay for this part of the debate, asked me specifically to mention that, because it is a matter of great concern, not least because it will have an impact on other maternity services in the area.

We are still suffering the effects of the closure of the A&E departments at Hammersmith and Central Middlesex hospitals last September, including four-hour waiting times at other hospitals such as Charing Cross hospital in my constituency, which is persistently below target. At the same time, stroke services are being centralised at Charing Cross for at least the next five years, having been transferred from St Mary’s hospital, although the plan is to move them away in due course.

In the last two years, £33 million has been spent on consultants just for the purposes of the “Shaping a healthier future” programme, of which £12.5 million was spent on a single consultant, McKinsey. That is £27,000 a day, and it could pay for 300 new nurses. Imperial College Healthcare NHS Trust is spending one eighth of its staffing budget on bank and agency staff, and the most recent figures show that it had an £18.5 million deficit.

Against this crisis—and it is a crisis—in A&E, the proposal in relation to Charing Cross, a major emergency hospital in my constituency, is that all its buildings be demolished, that its beds be reduced from 360 to 24, and that it lose all consultant emergency services. The population of London, and of west London in particular, is going to go up massively over the next 10 years. That is unprecedented. This is a very poor scheme, not just clinically for the reasons that the Royal College of Emergency Medicine gives, but logistically, spatially and financially.

I am grateful to the Minister and the Secretary of State for the opportunity, at last, before the summer recess to meet and discuss these matters in depth. I will therefore say no more about them today. I look forward to that opportunity, and I know the Minister will attend in good faith and look at the concerns we all have about the “Shaping a healthier future” programme. These are not idle concerns. It is obviously in the Whips’ brief for Government Members to say, “Let’s not make the NHS a political football,” but I do not think any Opposition Member is doing so. We are not in an election period.

[Wes Streeting (Ilford North) (Lab)]

It is a bit rich for Government Members to accuse us of using the NHS as a party political football, when prior to the 2014 local elections the Ilford North Conservative Association put out a leaflet claiming that King George hospital’s A&E would not close, when before the general election we were told its closure would be reprieved, and when the NHS trust chief executive has now told us that the closure plan will be published in the next six to nine months. That was playing party politics with the NHS, cynically.

[Andy Slaughter]

My hon. Friend makes a very good point. I make sure that every time I refer to what is happening in my local NHS now, I look into the voluminous papers on “Shaping a healthier future”, or what the Imperial College Healthcare NHS Trust actually says, so that I am clear that I am describing what is happening, not giving my opinion or saying something that has come from a party political standpoint. I simply wish that the Government would listen and respond in kind.