Irish Diaspora in Britain

Diane Abbott Excerpts

Thursday 17th March 2022 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

As the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) said, we are all a bit Irish today. It gives me a great deal of pleasure to speak in this debate because this is a subject that is important to me for many reasons. I would like to acknowledge all the Members here today who were either born in Ireland or are of Irish extraction, whatever party they represent. Of course, I salute all my constituents, everyone in this country and everyone around the world who is celebrating St Patrick’s day today.

I would like to pay a special tribute to our former Labour colleague and Member of this House, Jack Dromey, who sadly died earlier this year. I knew Jack long before he was an MP—in fact, when he was a firebrand trade unionist energetically involved in the Grunwick dispute. That dispute engaged Jack because it was about mainly Asian women striking against their extreme exploitation, low wages and terrible conditions in their factory, which led to them being sacked when they tried to form a union. As a proud Irishman, Jack was vehemently opposed to any idea that these women could not be unionised, and he was determined to fight for those mainly migrant workers.

That brings me to my first substantial point, which is why we, as immigrants or the children of immigrants, came to be here in the first place—because of course we are, all of us, descendants of the children of empire. It is a great credit to the people of Ireland that they have the honour of having set in motion the end of colonialism and the end of empire. I know that is a controversial view in some parts of this House, but my starting point is the position of a colonised people. My concern is not for the nostalgia and relics of the past, but the truth is that the people of India are only now recovering their former wealth and place in the world after the raj, and the people of China are recovering from having been effectively carved up by foreign powers. The people of Ireland now have a greater per capita GDP than this country. Yet before independence all these countries lived in abject poverty. I say that not to disparage anyone, but it confirms my view that no people can prosper while they are not free. In the approximately 100 years of British rule in India, the population fell substantially. We know that the Irish fared even worse. So all around the world there is a special place of pride reserved for the Irish, who began the end of empire, and there is a certain pride and a certain outlook that is conferred on many Irish people and people of Irish descent as a result.

I would like to convey my own personal experience of growing up in a part of west London not too far from where Jack Dromey did—Kilburn, which had, when I was a child, a very large Irish community. Others who migrated to this country came from the east and settled in the east end of London, but Irish—and, to a great degree, the West Indians—came to west London. The infamous sign, “No Blacks, No Dogs, No Irish”, came from that time and place. I grew up in that part of London when it was famous for its so-called race riots, but they were not race riots at all; they were rampages by white racist gangs and fascists. One even called itself the White Defence League, showing that it was continuing to play the same old tired songs.

My mother never tired of telling me about a time when one of those white fascist gangs came rampaging down our street knocking on doors to find out if black people owned the houses. Although our house, which was in Paddington, was a three-storey house, we only lived in one room—the rest of the house was occupied by tenants. That is how my parents could afford to pay the mortgage. In the basement was an Irish family headed by my Uncle Jimmy. The white racists were going up the street knocking on doors. Uncle Jimmy thought the absolute world of me; he adored me. I was a little baby. My mother used to give me breakfast and then she would take me down to Uncle Jimmy’s, and he would give me another breakfast. When he heard the white racists rampaging up the street, he said to my mother, “They’re not going to get our Diane”. He went up the stairs and opened the front door, and when the racists saw a white man there, they assumed he owned the house and went away. I suppose the pride and self-confidence that comes from slaying colonialism works its way down to the individual level, so even those rampaging white racists and white supremacists cannot frighten you. I will of course always be grateful to my Uncle Jimmy.

For 20 years before 1998, as some Members have mentioned, there were what were known as the troubles. To some of us observing at the time, it felt like low-level warfare, and l think the participants on all sides regarded it the same way. One of the features of war in general is that there is hardly ever a participant who looks back on it fondly. There is nearly always regret and sorrow, and I think that regret is true for the vast majority of the combatants in the troubles on every side, whether they were loyalists, republicans or part of the forces of the state. One of the reasons it took so long to get to the Good Friday agreement in 1998 was how the conflict was portrayed, including Britain’s own role in it. Many argue that there was a refusal to understand the Unionist population and their feelings, a denial of Britain’s role and a determination to demonise rather than understand Irish republicanism.

Well, we have come a long way. Irish republicans, such as Gerry Adams and his departed comrade Martin McGuinness, have both been invited to No. 10 many more times than most Members of this House. There is a reason for that. People may not like it, but Irish republicanism represents an ideal that harks back to at least the 18th century, based on ideas of anti-feudalism and national democracy. It was conditioned by the partial defeat of empire 100 years ago and transformed by the emergence of the civil rights movement. These were ideas with mass popular support, but successive Governments refused to see that or accept it, even after Bloody Sunday. Finally there has been an official apology for Bloody Sunday, but no prosecutions.

As we celebrate St Patrick’s day in this debate, I express my concern about the dangers to the Northern Ireland protocol from current political debate. It is as if some people have learned nothing and are determined to repeat their mistakes. This time it is different. In the words of the great Robert Emmet, Ireland has survived to take its place among the nations of the earth, and everyone who values freedom should rejoice in that.

Children’s Mental Health

Diane Abbott Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

My hon. Friend is entirely right, and that is why we are here today. Our children deserve better; they cannot go on like this. That is why we are talking about measures that can help to ameliorate these difficulties so that no child has to wait that long, and their families do not have to wait that long for answers. This is not okay.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree that among young people, black and minority ethnic young people often experience particular mental health pressures? There must be more analysis of the support that they and their families need.

[Dr Allin-Khan]

As always, my right hon. Friend is a powerful advocate for all groups, but particularly when it comes to black and minority ethnic groups. We do not have the data—we do not collect the data—even to understand the scale of the issue. I think that that is convenient for the Government, because it means they do not have to accept that there is a problem which needs to be dealt with.

That is one of the issues for the future. We have to understand the true scale of the issue when it comes to some minority groups, and tailor support that helps them specifically. When people from minority groups are seeking help, often it is so difficult for them to make a connection with people who understand some of the particular social pressures they live with at home and some of the societal issues they have to deal with that also contribute to mental ill health—for example, systemic racism. My right hon. Friend is absolutely right to bring that up.

We have a range of public health measures in place for children—check-ups for eyesight, hearing and growth—and vaccinations to protect against measles, mumps and rubella, yet we ignore the wisdom of the ages when it comes to children’s mental health. As a doctor, I know that adverse childhood experiences are a key contributing factor to poor mental health in adulthood. In A&E, I see increasingly younger children coming in having self-harmed or living with eating disorders. It is simply heartbreaking, and for parents it is absolutely agonising. Parents bring their children to A&E wondering why they are fainting repeatedly and are constantly exhausted.

Health and Care Bill

Diane Abbott Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

from the scope of the Public Contracts Regulations 2015.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree that the Bill has the sense of being an NHS corporate takeover Bill? We have already seen £5 billion in contracts being awarded to private companies through the VIP lane. The Bill opens the door to private corporations sitting on 42 local health boards. That is wrong.

[Margaret Greenwood]

I thank my right hon. Friend for putting the case so clearly. She hits the nail absolutely on the head: as a result of the Bill, contracts could be handed out to the private sector without the stringent arrangements that one would expect in the awarding of public money. That is a recipe for the kind of cronyism that has become all too familiar, as she says.

I turn to the cap on care costs. I was proud to stand on a manifesto in 2019 that pledged to

“build a comprehensive National Care Service for England”,

to include

“free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”

The Conservative manifesto in 2019 did not go that far, but it at least made the guarantee that

“nobody needing care should be forced to sell their home to pay for it.”

We now know that that was a sham—another broken promise by this Government.

Last week, Ministers sneaked out changes to social care plans that would mean that poorer pensioners will not after all be able to count means-tested payments by the state for their care towards a total cap of £86,000 for any individual. The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), described it as “deeply disappointing” that the new plans were “not as progressive” as those put forward by Andrew Dilnot, the economist who drew up the original plans for a cap on individual contributions. Mr Dilnot has said that the Government’s plan is

“a big change that…finds savings exclusively from the less well-off group.”

A former Conservative Cabinet Minister has urged the Government

“to adopt a different approach”,

while another Conservative MP, a former Under-Secretary of State for Health, has said that

“it will be poorer pensioners who have relatively modest assets that will be most affected by these changes.”

I hope that Members on the Government Benches are listening to those points from Government as well as Opposition Members and will do the right thing. Elderly people deserve better. All Members, including Government Members, have a responsibility to vote these measures down.

When the Prime Minister was discharged from hospital in April 2020, having spent seven nights there, of which three were in intensive care, he said that

“the NHS has saved my life, no question.”

Now he and his Government should save the NHS by withdrawing the Bill. The national health service is this country’s greatest social achievement. It is devastating that this Conservative Government are intent on taking it off us.

Covid-19 Update

Diane Abbott Excerpts

Tuesday 14th September 2021 Commons Chamber

[Sajid Javid]

My hon. Friend is right to raise that point. That is why we have kept our travel rules relating to covid constantly under review. He may have heard that I referred in my statement to a set of changes that we are looking to make, and my right hon. Friend the Transport Secretary will bring those changes to the House as soon as he possibly can.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State is quite correctly urging people to get vaccinated. He will be aware that, sadly, certain ethnic minorities have relatively low vaccine take-up, and we see that in my borough of Hackney. Has he considered anything that the Government could do nationally to support outreach to ethnic minority communities?

[Sajid Javid]

The right hon. Lady makes an important point. We want everyone to take up the offer of a vaccine, and she is right to point out the disparity in take-up in certain communities. The good news is that—I think partly as a response to Government action and especially because of the fantastic people I have come across in London working for Public Health England, who have worked with and reached out to communities to increase uptake—we saw a significant increase in uptake over the summer in the communities to which she referred. That work continues, and it remains a priority.

Black Maternal Health Week

Diane Abbott Excerpts

Tuesday 14th September 2021 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I am grateful for the opportunity to speak in this important debate on an important subject. I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), who made it possible. In particular, to speak in Black Maternal Health Awareness Week feels right and appropriate.

For all mothers-to-be, pregnancy is a challenging time, as I remember. Pregnant women feel vulnerable as their bodies are changing. For a first-time parent, in particular, the uncertainty of parenting can be daunting. It is very important that all mothers-to-be have access to high-quality services. Many do, thanks to our NHS. Our NHS is staffed by so many dedicated professionals, who provide exemplary support for many new mothers.

I want to make it clear that this debate is not designed to berate or admonish hard-working NHS staff. In fact, many staff in maternity services are black. Nevertheless, as colleagues have said, the extraordinary disparities in black maternal health cannot, and must not, be ignored any longer. I am aware that the Government do not like to talk about racial disparities, but Ministers can scarcely blame black women themselves for the disparities in maternal outcomes for black women.

The time is now for the Government and those in charge of the NHS to take these issues seriously. As Members have said, statistics show that black women in the UK have a fourfold higher increased possibility of dying in pregnancy, compared with their white counterparts. Disparities in mortality rates extend to babies as well as mothers. Mortality rates remain higher for black, black British, Asian or Asian British babies. That must have something to do with the disparities in the whole area of the maternal experience.

As a number of Members have said, these statistics show that there is a major problem in maternal health. So, the question is this: what are we going to do about it? To NHS managers and commissioners who may listen to this debate or read the transcript of it, I would ask: how will you ensure that black women are listened to? A number of Members who have spoken in this debate have made the point that black women, however confident and educated they might be in other circumstances, do not feel that they are listened to when it comes to the maternal experience. How will we close the pain gap, to ensure that black women are not left to suffer without the pain relief that apparently is readily given to white mothers?

The 2019 NHS Long Term Plan is a start, but it lacks concrete steps to address this disparity. It makes no mention of addressing disparities even in the administration of pain relief, among other things. I am hopeful that the Minister will touch on these issues when she responds to the debate.

So I say to the Government: what is the plan to address these disparities? What explanation can be given for them? Ministers have said in the past that we no longer see a Britain where the system is deliberately rigged against ethnic minorities. If they believe that, what will they do about the disparities in maternal outcomes?

If the Government and those managing our NHS wish to close this gap, they have to put black women at the centre of their thinking and listen to what they say about their experience, both after and during childbirth. That means that there must be clear and binding targets, data collection and monitoring to support and judge progress on this issue. It also means funding for new and existing projects to tackle this disparity and to take the measures that I and others have outlined.

I thank campaigners, such as those at Five X More, who have worked so hard to ensure that this matter is not forgotten. Black women and their babies deserve better. At no point in any woman’s life does she feel more vulnerable than in childbirth, and black women should not have to believe or understand that they will have a poorer outcome simply because of the colour of their skin and their babies’ skin.

--- Later in debate ---

[Anne McLaughlin]

I completely agree with my hon. Friend. It is up to the many Members of this House who are not already doing it to do it, and those of us who are doing it must keep repeating over and over again that black women are four times as likely to die during pregnancy and childbirth as white women. For women from mixed backgrounds it is three times as likely, and for Asian women it is twice as likely.

The reason we need to keep saying that is that, despite the fact that the inequality and disparity in maternal and newborn health has been highlighted for many years, we still do not fully understand why it exists, as we have heard, and we do not have the targets that we need to tackle it. The right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, of which I recently became a member, said that the statistics are so stark that there should be immediate change. She called on the Government to meet ambitious targets rapidly, and I completely agree.

In the previous debate on this matter, I focused on some of the shocking statistics that MBRRACE-UK highlighted in its confidential inquiry into maternal deaths; I shall repeat some of them. For every 100,000 women who gave birth between 2016 and 2018, 34 black women, 25 mixed ethnicity women and 15 Asian women died, compared with eight white women. Behind those numbers are people—women and babies. Compared with babies of a white ethnicity, black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death, and the gap has been widening since 2013. So there are these tiny human beings—boys and girls—who never got a chance at life. There are grieving fathers and husbands. There are whole families and whole communities.

In addition to the higher mortality rates, other concerns include the number of near misses and the number of times that women have felt that their voices have not been heard because of their skin colour. The hon. Member for Vauxhall (Florence Eshalomi) described a terrifying experience, when she must have felt completely powerless. That is wrong. I was shocked to hear many stories of mothers denied pain relief or left to suffer with undiagnosed post-partum conditions. I know that these things happen to women who are not black—it is always wrong—but for someone to be treated differently because of their skin colour surely compounds the problem. Just as we would research and address any medical causes of these things, we must research and address this issue. I echo the calls of the hon. Member for Streatham for the Government to address it.

As someone who is white, it took me some time to learn that people who are black just know when someone’s behaviour towards them is because of their skin colour. It is hard to explain. It was hard for me to understand at first, and obviously it is harder for me as a white woman to explain it because I do not experience it, but I have no doubt about it. I encourage everyone who does doubt it to really listen to what black and Asian mums are saying and trust that they just know.

NHS GP Dr Adwoa Danso has pointed out that instances of medical mistreatment have impacted on black, Asian and minority ethnic communities’ faith in the health services, and we saw that when it came to getting the covid vaccine. There is a further suggestion that, as the majority of migrants are disproportionally black, Asian and mixed ethnicity, the Home Office’s hostile environment immigration policy makes public services incredibly difficult to access. The right hon. Member for Hackney North and Stoke Newington (Ms Abbott) talked about the hostile environment and has campaigned hard against it for many years.

Women seeking asylum have been blocked or refused by reception staff acting as gatekeepers, often in conjunction with expectations or experiences of prejudice and discrimination. The hostile environment also leads to decisions such as taking women seeking asylum out of supportive communities and into places such as the so-called mother and baby unit in Glasgow, where tiny babies are put in tiny rooms with not even enough room to crawl. The frustrating thing for me as an MP representing Glasgow North East, in a country where we have our own Government, is that our Government can do nothing about it because all the decisions about it are taken down here in Westminster.

[Ms Abbott]

Does the hon. Lady agree that the hostile environment affects not just the pregnant women themselves but may well affect black staff, who feel, as we have heard, frightened to speak up about what they are seeing?

--- Later in debate ---

[Ms Dorries]

The hon. Lady is absolutely right. I am very proud of the work that we have done in the Department of Health and Social Care, and in the NHS, to improve maternal outcomes for everyone, particularly over the last few years. The statistics speak for themselves. However, I will focus on the issue of black women and maternal health, because there is a great deal that we have done since the hon. Member for Streatham had the last debate. I am looking forward to informing her about the work that has been undertaken since then. I thank her for instigating this debate, and I hope that she continues to hold our feet to the fire. It is important that people do raise this issue, as she does, as often as possible in Parliament.

In response to the incredibly articulate speech by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), it is right to raise the report by the Health and Social Care Committee, which I will respond to next week. A number of the questions that have been asked today will be included in that response, so I will not steal my own thunder—I will wait to provide a response next week.

I thank the co-founders of the Five X More campaign, Clotilde and Tinuke, and all the health care professionals and organisations who campaign to raise awareness of this week. I have visited Tommy’s maternity unit three times now, and the hon. Member for Streatham is right to raise the point that the majority of staff, doctors and midwives are black. I am incredibly impressed with the way that Tommy’s addresses this issue; they are pioneers in addressing maternity inequalities and outcomes, and they do fantastic work. I pay tribute to Tommy’s, and all hospitals, who I know are putting their weight behind reducing maternity inequalities and outcomes—Tommy’s is certainly at the forefront of that work. My granddaughter was born at Chelsea and Westminster hospital, so I thank them too—they are pretty amazing as well.

This debate comes a few days before this year’s World Patient Safety Day; the theme this year is safe maternal and new born care. It provides an opportunity to mark the progress made across the system in improving outcomes and safety, but also to recognise that further work is needed. At its best, NHS care offers some of the safest maternal and neonatal outcomes in the world. However, the disparities that exist between black and white women in pregnancy and childbirth experiences are unacceptable. I am committed to both reducing this disparity in health outcomes, and improving the experience of care.

We cannot beat around the bush any longer on some of the reasons why we experience these inequalities. They are complex, and there is no one answer as to how we can address this subject. Personal, social, economic and environmental factors all play a part; we must address the causes of disparities to improve outcomes and experiences of care. I was delighted that last week NHS England and NHS Improvement published their equity and equality guidance, which responds to findings that maternal and perinatal mortality show worse outcomes for those in black, Asian and mixed ethnic groups. They invested £6.8 million in the guidance to improve equity and equality action plans, and implement targeted and enhanced continuity of care.

We know that pregnancy lasts around 40 weeks. However, when a woman walks into a hospital to give birth, those 24 or 48 hours—however many hours she is in hospital—are not what wholly contributes to her experience of the healthcare sector, or her outcome. A lifetime approach is needed to address some of the reasons why some women are more at risk of poorer outcomes than others. We know that there are many health issues that contribute to poorer outcomes in pregnancy, including alcohol, obesity and smoking. The chief medical officer recently published a report that showed that, in some of our seaside towns, 25% of women are smoking at the beginning of pregnancy. I think the figure was that 22% were still smoking by the end of their pregnancy. There are inequalities and health disparities that we really need to address.

For that reason, we have established the newly formed Office for Health Improvement and Disparities, which launches on 1 October, to target those health disparities, including racial and ethnic disparities in health, and to improve pre-conception health to support women to be in their best health throughout pregnancy.

[Ms Abbott]

rose—

[Ms Dorries]

I will just finish the point on the office of disparities, because it is quite important. It is a huge step to establish an office that will actually deal with this particular issue. It will tackle inequalities across the country, and will be co-led by the newly-appointed deputy chief medical officer, Dr Jeannelle de Gruchy.

The office will be a vital part of the Department of Health and Social Care, and will drive the prevention agenda across Government to reduce health disparities. I hope the hon. Member for Streatham welcomes the establishment of this new body to tackle the top preventable risk factors for poor health, which include obesity, unhealthy diets, lack of physical activity, smoking and alcohol consumption. Equity and equality guidance will also be issued.

It is a huge step to look at those lifetime health experiences that contribute to what happens at the point of delivery and throughout pregnancy. Until we improve, and look at what happens before, using a lifetime view of health that includes women’s experiences of health throughout, then tackling what happens when they walk through a labour ward door will continue to be very difficult.

[Ms Abbott]

I think everyone present welcomes the establishment of the new office. The Minister has mentioned obesity, alcohol and smoking as risk factors in pregnancy; I take it she is not suggesting that the disproportionate outcomes we have for black women are because we are more likely to be obese, smoke or drink.

[Ms Dorries]

No.

[Ms Abbott]

I just wanted to get that clear.

[Ms Dorries]

Absolutely. The office will look at all pregnancies, and the negative contributing factors. I believe that one in four women—black and white women—who present in labour are obese. That has an incredibly high risk factor during labour, so it is to address inequalities across the board. My right hon. Friend the Member for Romsey and Southampton North mentioned socio-economic groups, and the disparities they experience: smoking, alcohol and other negative factors that contribute during pregnancy are across the board, and they need to be addressed. That is the reason why the office has been established.

The cessation of smoking during pregnancy was something we campaigned on a lot in the past. I have noticed, probably since we passed the legislation to ban smoking in many places, the emphasis has almost come off the importance of not smoking during pregnancy. The CMO’s report highlights that, in some areas of low socio-economic grouping, 25% of women are starting pregnancy smoking. That highlights the fact that we need to put more emphasis on, and focus on, those health disparities.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Jo Churchill]

Cancer has been prioritised with funding throughout the pandemic. It is, as I say, a key priority. Not only have we invested in radiotherapy equipment to the tune of some £325 million but there is a £160 million initiative to provide covid-friendly cancer treatments that are safer for people. We still have the same objective in the long-term plan to diagnose more cancers early, and appropriate funding, such as the billion pounds targeted at the NHS to drive down cancer backlogs and to ensure that people can access care, is part of that strategy.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

What estimate he has made of the level of covid-19 vaccination among (a) black and (b) white people in the most vulnerable groups.

[The Minister for Covid Vaccine Deployment (Nadhim Zahawi)]

Overall, we are encouraged by the vaccine uptake in the most vulnerable groups, with more than 17.7 million people in the UK having now received their first vaccination. To date, black people, who account for around 3% of the population, make up 1.7% of those vaccinated, while white people, who account for 86% of the population, make up 82% of all those vaccinated in England. We appreciate that there is still work to do, and our vaccine uptake plan addresses that.

[Ms Abbott [V]]

Will the Minister speak to Public Health England and ensure that local directors of public health make this information and other information in relation to specific cohorts available at a borough level to local MPs? He will be aware that the danger is that we could be hitting our vaccination targets overall, but certain groups are left behind. Many local MPs want to have some transparency about what is happening locally.

[Nadhim Zahawi]

I am grateful for the right hon. Lady’s question. She and I visited the Hatzola first responders, who did an incredible job that Saturday night of vaccinating 364 people from not only the Haredi Hasidic Jewish community but the Muslim community as well. Our uptake plan has four key enablers: working in partnership with local government and directors of public health; removing barriers to access—in other words, access being available at the time and place that people need it; data and information, which we share with directors of public health, and we want to share it in more granular ways; and, of course, engagement, engagement, engagement.

Covid-19 Update

Diane Abbott Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

I do not underestimate the impact that all these measures have had on Gatwick. My hon. Friend represents so many of those who work at Gatwick, and I understand the impact. I was at Gatwick airport on Friday, and the empty departure hall was really quite a sad sight. These measures are necessary, in my view, and I am glad that he supports them, difficult as they are. We are also acutely cognisant of the economic impact on airports and those who work in them, and I would be happy to keep talking to him about how quickly we can remove these measures safely.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab) [V]]

The whole House has welcomed what the Secretary of State has had to say about the progress in fighting coronavirus, but he will be aware that there is a very real danger that one cohort will be left behind: black and ethnic minority communities. We already know that black people are four times more likely to die from coronavirus, and currently the statistics show that black over-80s are half as likely to be vaccinated as white people. I am conscious that the Minister for Covid Vaccine Deployment is aware of this issue, but will the Secretary of State give the House an undertaking that he will drive forward a whole series of measures to increase vaccine take-up among black and minority ethnic persons? When black and minority ethnic people are on the frontline of the fight against coronavirus as health and social care workers, it would be a tragedy if there was an increased death toll because enough was not being done to encourage take-up of the vaccine.

[Matt Hancock]

I do not say this lightly, but I agree with every single word that the right hon. Lady said. I want to pay tribute to her, because I have not had the chance in the House to thank all the black MPs who took part in the incredibly moving video to persuade people, who may have understandable concerns, that taking the jab is the right thing to do. She played a pivotal role in that short video, and it is just one small part of the huge effort we need to make, because the fewer people who do not have the protection, the safer we will all be. I am very grateful for her work and her support, and I hope that we can continue to work together to drive uptake among black communities right across this country.

Access to Medical Cannabis

Diane Abbott Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

I pay tribute to my right hon. Friend and the all-party parliamentary group for their work in bringing this issue to the attention of the House and the country, and in supporting the parents involved. My right hon. Friend has been characteristically emphatic and reasonable in providing that support, and I entirely understand his concern. Meeting some of the parents as part of the APPG delegation was a very emotional experience.

Of course the Border Force staff were doing the right thing—and I am glad that they were doing it in a reasonable way—according to the existing rules, under which if a controlled drug is to be imported it needs a licence, and the import of an unlicensed controlled drug therefore requires a prescription from a specialist doctor. There are just over 95,000 registered specialist doctors in the UK. Any one of them who has the relevant experience can prescribe the drug, and it will be then allowed in. That can happen now. The guidance is not a barrier, and it is not a barrier to prescription. However, it is clear to me that this process is not working. I have therefore initiated a process evaluation, which is NHS language for looking at exactly why it is not working and what we need to do about it.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is shameful that we saw those scenes at Southend airport, and that families continue to suffer because the arrangements are so slow. It is, however, appropriate that we are discussing this issue on the day on which my hon. Friend the new Member for Newport West (Ruth Jones) has taken her seat, because her predecessor, my friend Paul Flynn, was an indefatigable campaigner for many important causes, including the legalisation of cannabis for medical use.

Last year Charlotte Caldwell, the mother of another sick child, Billy Caldwell, said:

“It’s absolutely incredible, it’s amazing. The compassion and speed that the Home Secretary has moved with is just incredible.”

That is the impression that Ministers sought to give, but it was a misleading impression, as the plight of the Applebys revealed this weekend.

Is the Secretary of State aware that cannabis oil is not the same as cannabis, and that it has no psychoactive or addictive effects? Is he aware that in other jurisdictions a range of conditions qualify for treatment with cannabis oil and related products, including cancer, AIDS, muscular dystrophy, Crohn’s disease, epilepsy, Parkinson’s disease and arthritis? Is he aware that the Home Secretary has previously commissioned Sally Davies to examine the scheduling of cannabis as a whole? She reported as long ago as June 2018. Is the Secretary of State aware that Ms Davies’s report has been with the Advisory Council on the Misuse of Drugs since that time? Is the House to understand that the Home Secretary has just been sitting on it?

What is the Secretary of State going to do to speed up the processes around this issue? Parents will not be impressed to hear of further reports or further enquiries. We need to resolve the Appleby case quickly, but we also need to make sure that no other families of sick children have to suffer in the way the Appleby family is suffering.

[Matt Hancock]

I did set out the answers to those questions in my initial response. There are a number of smaller active agents in medicinal cannabis, but there are two major ones: THC and CBD. The vast majority of those who now have access to medicinal cannabis have access to CBD, and that is different as an active agent. Clinicians have to make a judgment according to the personal circumstances and needs of the patient, and I am trying to remove all the barriers to those clinical decisions.

We have taken action. I absolutely understand the history here, because the Home Secretary and I signed off on the decision to allow medicinal cannabis to be available at all on 1 December, following the chief medical officer’s report. What we need to do now is ensure that there are no further barriers to prescription where a clinician judges that that is the right thing to do.

NHS Sustainability and Transformation Plans

Diane Abbott Excerpts

Wednesday 14th September 2016 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I beg to move,

That this House notes with concern that NHS Sustainability and Transformation Plans are expected to lead to significant cuts or changes to frontline services; believes that the process agreed by the Government in December 2015 lacks transparency and the timeline announced by NHS England is insufficient to finalise such a major restructure of the NHS; further believes that the timetable does not allow for adequate public or Parliamentary engagement in the formulation of the plans; and calls on the Government to publish the Plans and to provide an adequate consultation period for the public and practitioners to respond.

I am glad to open this debate on the NHS sustainability and transformation plans. As the whole House knows, the NHS has a special place in the affections of our constituents. No other public service engages with us all when we are at our most vulnerable—in birth, death and illness—and the public and NHS staff are increasingly aware that the NHS is under severe financial pressure, a matter I will return to.

In that context of financial pressure and concern about the availability of services, the sustainability and transformation plans are arousing concern. They sound anodyne and managerial, and there is undoubtedly a case for bringing health and social care stakeholders together to improve planning and co-ordination. But the concern is that, in reality, the plans will be used to force through cuts and close hospitals, will make it harder for patients to access face-to-face consultations with their GPs, and, above all, will open the door to more privatisation. It tells the public how little the Secretary of State cares about their concerns that he is not in the Chamber to listen or respond to this debate. We know that recently he has missed all seven recent meetings of the NHS board. The public are entitled to ask how much he cares about their very real concerns.

[Helen Whately (Faversham and Mid Kent) (Con)]

The hon. Lady mentioned cuts, but this Government are putting more money into the national health service—an extra £10 billion a year. The Labour party had no intention of making that sort of financial commitment to the NHS, as we saw in its failure to do so before the last election.

[Ms Abbott]

The NHS was never better funded than under the last Labour Government and the public know that. That is why they trust us with the NHS.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the hon. Lady give way?

[Ms Abbott]

I need to make progress.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will my hon. Friend give way?

[Ms Abbott]

Yes.

[Hon. Members]

Ah!

--- Later in debate ---

[Steve McCabe]

I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?

[Ms Abbott]

It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.

One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.

[Sir Simon Burns (Chelmsford) (Con)]

Will the hon. Lady give way?

[Maria Eagle (Garston and Halewood) (Lab)]

Will my hon. Friend give way?

[Ms Abbott]

I give way to my hon. Friend.

[Maria Eagle]

I am grateful to my hon. Friend for giving way. We have a leak of the STP for Merseyside and Cheshire, which states that there is an “appetite for hospital re-configuration” because the existing set-up is “currently unaffordable”. Given that it also says that almost a £1 billion gap is to be expected by 2021, and that the public have not yet been consulted, does my hon. Friend agree that when the public are consulted, there will be an absolute outcry?

[Ms Abbott]

That is the reason for the secrecy thus far. The Government know that if the public understood what STPs meant, there would be an outcry.

[Norman Lamb (North Norfolk) (LD)]

Does the hon. Lady agree that unless the local community are fully engaged in the process of considering how the health and care system needs to change their area, the process is destined to fail and simply will not work?

[Ms Abbott]

I am grateful to the right hon. Gentleman. For nearly the whole time I have been in Parliament, there have been attempts to reconfigure hospitals and close A&Es and make other changes in London. We have found that when the local community does not take ownership of the plans, it is impossible to take them forward. That secrecy runs counter to making the reorganisations we might have to make.

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

Initially, the STPs were discouraged from publishing their draft plans, freedom of information requests were met with blank replies, and enquirers were told that no minutes of STP board meetings existed. We are therefore bound to ask: if the plans are really in the interests of patients and the public, why has everyone been so anxious to ensure that patients and the public know as little as possible?

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

In some cases, even local GPs have not been fully involved in decision making. Hon. Members may not take that seriously, but I assure them that their constituents will. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is up to the hon. Lady whether she wishes to give way or not. Shouting and screaming will not help with the debate, because Members on both sides want to hear. I am sure that, when she wants to give way, she will do so, but screaming will not help, and it certainly does not help my ears.

[Ms Abbott]

GP leaders in Birmingham said that it would appear that plans by the STP to transform general practice, and to transform massive amounts of secondary care work into general practice, are already far advanced. Only at this late stage have they been shared with GP provider representatives.

[Alex Cunningham (Stockton North) (Lab)]

Freedom of information requests have also uncovered the substantial role of the private sector in formulating these plans. GE Healthcare Finnamore, for example, is advising STPs across the south-west, and I have no doubt that work is under way for it to get larger slices of the action in the future. In the name of transparency, does my hon. Friend agree that all their boards should publish everybody who is on them, with their declared interests as well?

[Ms Abbott]

I entirely agree with my hon. Friend. All STPs should publish who is on them, what their financial interests are, and how far advanced they are in planning. However, thanks to the work of organisations such as Open Democracy and 38 Degrees—and, frankly, thanks to leaks—the picture of what STPs will mean is becoming clearer.

We know from the information we have been able to glean that the reality of STPs is quite concerning. For instance, in the black country there are plans for major changes to frontline services at the Midland Metropolitan hospital, including the closure of the hospital’s accident and emergency. The plans also propose to close one of the two district general hospitals as part of a planned merger. We know that by 2021 the health and social care system in the black country is projected to be £476.6 million short of the funds it needs to balance its books. [Interruption.] Government Members may shout now, but they are going to need an answer for their constituents when the reality of some of these proposed closures becomes apparent.

In Leicester, Leicestershire and Rutland, there are apparently plans to reduce the number of hospitals in the area from three to two. By 2021, the health and social care system in the area will be £700 million short of the money it needs to balance its books. In Suffolk and north-east Essex, the STP plan refers to the

“reconfiguration of acute services within our local hospital, Colchester Hospital University Trust”.

The whole House knows that, historically, reconfiguration in the NHS has meant cuts. There are also plans to close GP practices.

The context of these plans, of which I have given an idea, is the current NHS financial crisis. Most recently, we have heard from NHS providers about this financial crisis. They represent the NHS acute, ambulance, community and mental health services. NHS providers say that despite the best efforts of hardworking staff, including junior doctors, hospital accident and emergency performance is the worst it has ever been. Waiting lists for operations, at 3.9 million, are the highest they have been since December 2007. We ended the last financial year with trusts reporting the largest deficit in the history of the NHS: £2.45 billion.

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

I have to make a little progress.

Many STPs will be facing a large financial deficit. [Interruption.] I have to say to Government Members that they do not seem to be taking this debate seriously. When their constituents come to them asking about these cuts and closures, they will have to take it seriously. Many STPs will be facing a large financial deficit, which is subject to “control totals”—that is, cuts. In the case of north-west London, which does not have the largest projected deficit by any means, spending on acute care is projected to fall in nominal terms over a six-year period, despite a population that is both increasing and ageing, and despite cost pressures such as the sharply rising cost of drugs.

STPs have made an assessment of their own deficits by 2020-21. Researchers have disclosed that approximately 29 of the 44 STPs have projected substantial deficits.

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

I have to make some progress.

[Richard Fuller (Bedford) (Con)]

On a point of order, Mr Deputy Speaker. Is it a requirement for a Member of this House to know the difference between a debate and a monologue?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

It is for me to make that decision. I am quite happy for the shadow Secretary of State to decide whether she wishes to give way or not. In fairness, this is an Opposition debate, and the hon. Lady is leading it. Let us not have any more pointless points of order. I am worried about how many Members want to speak; I want to try to get everybody in.

[Ms Abbott]

So when the STPs talk about efficiency, they actually mean cuts. Increasingly at the heart of these STPs are asset sales of land or buildings to cover deficits. No wonder the leader of Hammersmith and Fulham Council, Stephen Cowan, has said of his local STPs that

“this is about closing hospitals and getting capital receipts”.

He went on:

“It’s a cynical rehash of earlier plans. It’s about the breaking up and the selling off of the NHS.”

[Sir Simon Burns]

rose—

--- Later in debate ---

[Ms Abbott]

I need to make some progress.

The King’s Fund has said:

“There are some concerns that NHS leaders have focused their efforts on plans for reconfiguring a few hospital services, despite evidence that major acute reconfigurations rarely actually save money and sometimes fail to improve the quality of care.”

The BMA has said the same thing. The King’s Fund has also said:

“The cuts under the STPs are eye-watering”.

[Anna Soubry (Broxtowe) (Con)]

rose—

[Ms Abbott]

I am anxious to complete my remarks so that Conservative Members will all get a chance to intervene in the debate.

The Health Select Committee's recent report on the impact of the 2015 spending review stated:

“At present the Sustainability and Transformation Fund is being used largely to ‘sustain’ in the form of plugging provider deficits rather than in transforming the system at scale and pace. If the financial situation of trusts is not resolved or, worse, deteriorates further, it is likely that the overwhelming majority of the Fund will continue to be used to correct short-term problems rather than to support long-term solutions”.

[Sir Simon Burns]

rose—

[Anna Soubry]

rose—

[Ms Abbott]

Other aspects of the STPs that relate to cutting expenditure involve a combination of factors, including the use of new technology such as apps and Skype, patients taking more responsibility for their own health, “new pathways” for elderly care, increased reliance on volunteers and the downgrading of treatment by skills, responsibilities and pay bands. It seems to me that while some of these proposals might have some merit in themselves, it is delusional to imagine that they will deal with the financial black hole in the NHS. There is no evidence that among the patient population as a whole, increased use of apps, Skype and telemedicine can produce the efficiencies required while beds, units, departments and hospitals are being closed.

I remind Members, many of whom speak to their constituents in their advice surgeries on a weekly basis, that the truth about speaking to people face to face is that it is often towards the end of the conversation that people will come out with what really concerns them. My concern about the increased use of Skype is that many patients will not get the familiarity and comfortableness with their interlocutors to enable them to say at the end of the Skype session what it is that they are concerned about.

The STPs talk a great deal about increasing preventive medicine. That would indeed have the effect of lowering demand for acute NHS care, but it would also require a very substantial investment in public health programmes—and this Government have just cut public health funding. The elderly, the poor and patients for whom English is not their first language are the least likely to use these apps, telemedicine and Skype. It is inappropriate and unrealistic to assume that elderly patients who, I remind Members, are the biggest users of acute care and the fastest-growing demographic, will want to use Skype for any sensitive matter. “New pathways” for the elderly is sufficiently vague as an idea to raise alarm bells, given the projected rise in demand for geriatric services and continuing cuts in social care funding.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a very important point. She has already touched on the financial problems in the NHS, but allied to those are the financial problems in adult social care. We shall not have the truly integrated health and social care that we all desire when these STPs are being swept under the doors without people knowing precisely what they will mean for public services in their areas.

[Ms Abbott]

My hon. Friend has made an important point.

The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.

Let me now say a word about the increasing private sector involvement in the NHS.

[Sir Simon Burns]

Will the hon. Lady give way?

[Ms Abbott]

It was the NHS England director of STPs, Michael McDonnell, who said that they

“offer private sector and third sector organisations an enormous amount of opportunity”.

We know that PricewaterhouseCoopers has been heavily involved in the formulation of a large number of these plans, and we know that—as was mentioned earlier—GE Healthcare Finnamore, which was taken over by General Electric in the United States, has been heavily involved in the formulation of plans in the south-west and possibly more widely. The strong suspicion is that a combination of cuts, the reorganisation of services on a geographical basis, and the growth of hospital “chains” will facilitate greater privatisation of the NHS.

[Dr Murrison]

Will the hon. Lady give way?

[Sir Simon Burns]

Will the hon. Lady give way, and if not, why not?

[Ms Abbott]

Let me now draw my speech to a close. It is absolutely right that health and social care stakeholders should come together to plan for the future. It is absolutely wrong that social transformation plans should be hatched in secret and used as a cover for cuts and hospital closures—and it is increasingly clear that STPs may be a stalking horse for more privatisation. Conservative Members may not take this issue seriously—[Interruption]—and Conservative Members’ response may be to shout, but I stress to the House that the consequences of these STPs will be very material for all our constituents.

[Anna Soubry]

Will the hon. Lady give way?

[Ms Abbott]

They will also be very material for those who work in the NHS. I take this issue seriously. [Interruption.] That is why we have called the debate, and I wait with interest to hear what Ministers have to say.

Psychosis: Early Intervention

Diane Abbott Excerpts

Wednesday 7th September 2016 Westminster Hall

[Kerry McCarthy (Bristol East) (Lab)]

As ever, it is a pleasure to see you in the Chair, Sir Roger. I also welcome the Minister to her place.

Psychosis is incredibly frightening for friends and family to witness, and I speak from personal experience. It means people in effect having lost control of what is going on inside their head but not realising it, and it is difficult to get through to them. It is also an incredibly frightening experience for the people who suffer such episodes— perhaps not at the time, when they are in the grip of psychosis, but it becomes apparent from talking to them afterwards. One person, a veteran of the first Gulf war who has suffered from psychosis for the best part of 20 years, said, “You never know again whether what you are experiencing, feeling and thinking is true, because other people are telling you your experiences were not true.” It is an incredibly distressing place to be.

Early intervention is crucial. Mothers in particular have come to my constituency surgery, desperate to keep their young adult sons out of the criminal justice system, yet that is often the only alternative. These are big lads who can be quite frightening when they are in the grip of psychosis. The last thing a mother wants is to see her son locked up in police cells for the night, but all too often that has been the only alternative. If the lads are not seen as a direct danger to themselves or to others they cannot be sectioned; the mothers do not want them to be sectioned but they desperately want to get them help.

I pay tribute to the police and crime commissioner in my local area, Sue Mountstevens. She is an independent candidate who has just been elected for the second time, and she has made it an absolute priority to try to get people with mental health problems out of the criminal justice system and to make sure there are beds available so they can get the help they need.

We know that psychosis is particularly prevalent among young men of black Caribbean or African origin. Indeed, the three mothers who have come to me about this issue are all of black Caribbean or African descent. It seems to be an established fact that these young men are more vulnerable, but I do not think we have ever got to the root of why that is the case, and I would like to see more research into that.

I agree with what has been said about parity of esteem; I think all parties now recognise that. Mental health has been the poor relation of physical health, but young people’s mental health has too often been the poor relation of adult mental health. Young people struggle.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree that overall people of black Caribbean heritage are over-represented in the mental health system? These young men tend to present late. They tend to be less likely to get talking therapy and tend to have poorer outcomes.

[Kerry McCarthy]

I very much agree, and I would love to see more research into the reasons for that. We know that early intervention is crucial and that if there is intervention after the first episode of psychosis, it can be deflected further down the line. It may be that young men’s reluctance or the lack of access to those services means that they go on to develop full-blown psychosis, which then blights their adult lives. There could be all sorts of reason. I have heard my hon. Friend speak about this before. I know she thinks it is a really important issue, and I agree with her.

Young people are even more marginalised. I have the Riverside unit for young people in my constituency at Blackberry Hill hospital. It is part residential, part day placements. I visited it recently. If the spaces are full, a number of young people get sent a considerable distance from home and away from their friends and families for treatment, which is not ideal. If we are trying to deal with young people in very vulnerable circumstances, displacing them from their families and support networks is obviously wrong.

Dr Dominique Thompson, who is in charge of the GP services at the University of Bristol, has given me figures in the past about the proportion of the casework of GPs at universities that is now on mental health-based issues, and it has grown exponentially. That is everything ranging from anxiety, stress and depression right through to severe psychosis. I make a plea that the health services at universities are not the same as ordinary neighbourhood GPs; they need particular support. They deal with young people who are away from home and away from their support networks. We know that GPs are under pressure—particularly in terms of recruitment, which is a debate for another day—and it is important they have the resources to deal with that.

I want to mention briefly one source of help that is available to GPs. I met a group of researchers yesterday who are part of the Avon and Wiltshire Mental Health Partnership NHS Trust and are based at Blackberry Hill hospital in my constituency. They do something called BEST—best evidence summaries of topics—in mental health, which is a web-based service. Basically, these experts look through all the information available and distil it down to easy paragraphs for clinicians, so that rather than having to wade through all the material on the internet, clinicians are given some guidance as to what they are likely to be looking at and the likely best treatments. The funding for that service is under threat. A cross-party group of MPs from the Avon and Wiltshire area met those researchers yesterday. We think that the service should at the very least be piloted, with a view to rolling it out nationally, because it is a really valuable resource. We are going to write to the Minister about that, but I wanted to flag it up today.

Finally, I was looking this morning at the NICE guidance on early intervention in psychosis access. It pays passing reference to substance abuse, saying:

“Around 40% of people with first episode psychosis misuse substances at some point in their lifetime.”

I would like to see more research done into cannabis-induced psychosis. It is clear to me—partly from anecdotal evidence, but there is research out there—that partly because of the stronger strains of cannabis that are now available, more people are presenting with cannabis-induced psychosis. There may be a connection between that and people going on to develop full-blown psychosis, or people may have a cannabis-induced psychotic episode and then recover. Speaking partly from personal observation, I think that in some cases drug use makes it more difficult to diagnose when people are suffering first-time psychotic episodes. I would like to see more research into that.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this very important debate. The House appreciates his engagement with this issue, given all his wisdom and experience as a former Health Minister, and his continuing work since the 2014 paper “Achieving Better Access to Mental Health Services by 2020”.

Every Member of Parliament, on both sides of the House, will have had the experience in their own advice sessions of people coming to see them who either are experiencing mental health problems or are a family member trying to get help for a child or partner with mental health problems. I think that every Member of Parliament will also have somebody struggling with mental health issues within their own family or among their wider acquaintanceship, but it remains the case that the stigma around mental health issues means there is more concealment, more shame and more delay in reaching out to the NHS for the treatment and support that people need. We know that mental health issues are on the rise. We know that there is a relationship between recession, unemployment and mental health issues and we can see it in our communities across the country.

I have to declare an interest because my mother was a mental health nurse until she retired. She worked in a mental hospital called Storthes Hall in West Yorkshire, and like a lot of mental health facilities it was a former workhouse. Despite the dedication of the nurses and doctors who worked there, this former workhouse on the edge of the Yorkshire moors exemplified, in a very physical way, the Cinderella nature of mental health services.

All parties in this House are committed to parity of esteem between mental health and physical health, but this important debate tests that reality. As we heard earlier, mental health is not just an issue for the individuals concerned; it can have a very sad and serious effect on their families. My hon. Friend the Member for Bristol East (Kerry McCarthy) touched on the issue of black and minority ethnic men and psychosis. This subject is not often discussed in this House, so I will be forgiven for saying a little about it. It has been an issue for many decades that black and minority ethnic people are disproportionately represented in our mental health system at every level. If someone goes on to the wards of the Maudsley in south London or of mental health hospitals across London, they will see that a disproportionate number of the beds are filled by people of black and minority ethnic origin. In some cases, nearly all the beds are filled by people of black and minority ethnic origin.

This subject has been examined and studied since the book “Aliens and Alienists: Ethnic Minorities and Psychiatry”, which is by Dr Lipsedge, I think, and goes back to the ’80s. First, the issue is disproportionate representation, but then it is what sort of access to treatment people from black and minority ethnic backgrounds get. The first problem is their presenting late, and one of the reasons why black and minority ethnic people present late is that they are so frightened of the mental health system. I have dealt time after time with mothers who are struggling with sons with very serious psychosis whom they cannot manage and feel physically threatened by. When I say to them that they need to approach the national health service, they are often very resistant because they are so frightened. They believe that if they let their sons go into the mental health system, they will just be pumped full of—

[Sir Roger Gale (in the Chair)]

Order. I am sorry to interrupt the hon. Lady. I understand that she wishes to address the Member who moved the motion, but she is off-microphone and it is making it difficult for the Hansard reporter. That is why, traditionally, Members address the Chair.

[Ms Abbott]

It is true of many communities, and in particular the black and minority ethnic community, as the statistics prove, that they are reluctant to take family members into the national health system. When they finally have to engage with the national health service, their symptoms are much worse and it is far harder to get positive outcomes. I tell the Minister that it is really important to look at this issue of black and minority ethnic people and the mental health system, because it is causing real misery and problems within the community. We are less likely to be offered talking therapies and more likely to be offered electroconvulsive therapy. Again, mental health facilities within the prison service, such as Rampton, have disproportionate levels of black and minority ethnic persons inside those institutions.

[Norman Lamb]

I am grateful to the hon. Lady for giving way. She is making an incredibly important point about the over-representation of black and minority ethnic people in the system. Does she agree that they are also more likely to be subject to coercion—to sectioning under the Mental Health Acts—and more likely to suffer restraint and physical force within mental health settings?

[Ms Abbott]

I am grateful to the right hon. Gentleman for that important point. It is absolutely true that, partly because they are presenting late and often have quite advanced psychotic symptoms, they are more likely to experience coercion and restraint. We know that some of those incidents of restraint have had very unhappy outcomes, and families continue to campaign against the misuse of restraint on mental health patients. All these decades after people first started to look at issues relating to black and minority ethnic communities and the mental health service, we have made little progress. Is the Minister willing to meet me to discuss this issue, which I have looked at for many years? One of the basic problems is statistics. It took years to get the health service to keep statistics broken down by ethnicity within the mental health service, and I am not sure what is happening to those data.

As we have heard, it is vital that psychosis is treated early as that prevents complications, improves outcomes and is more cost-effective. We know that psychosis costs £11.8 billion a year and we also know that mental health problems are on the rise. It is very disturbing to find that the research shows that a quarter of CCGs seem to be ignoring the access waiting time standard for psychosis, and the National Audit Office reports that there are insufficient funds available for the strategy to achieve parity of esteem to have any reality. We know, because we have heard, that too many CCGs cannot even specify how much money is devoted to early intervention; that gives rise to the suspicion that not enough is devoted to it.

The right hon. Member for North Norfolk made the fundamental point that this issue is still not being treated with the same seriousness as cancer standards are. This goes back to the issue that many Members have raised of stigma, shame and an unwillingness of the families of psychosis sufferers to speak out in the way that the families of people who suffer from cancer are willing to go into the public space and to the media to speak out.

[Johnny Mercer]

I wholeheartedly agree with the hon. Lady about that. This week, in Plymouth we have been running a campaign called “Talk Don’t Suffer”, in conjunction with The Herald. I pay tribute to the Plymouth Herald for what it has done. Getting people to come forward and printing their stories is such a powerful testimony for those who suffer with mental health, because they know that other people are suffering too and about the impact on families. To talk about it is very important to improving the situation.

[Ms Abbott]

I again congratulate the right hon. Member for North Norfolk on securing this important debate. He spoke about discrimination and injustice, and that is what strikes people so strongly. There is the human misery of people suffering from psychosis, whether intermittent bouts or lifelong psychosis, and there is the misery and worry of their family members. We need to be a society in which the promise from all parts of the House for parity of esteem between mental and physical health becomes reality. We want to be a society in which people are not marginalised or almost warehoused just because they have mental health challenges, including psychosis, but have some promise of the support they need and of a better life. I look forward to the Minister’s response to questions asked by my Opposition colleagues. I assure her that I will return to this issue—not only black and minority ethnic mental health, but mental health in general.

--- Later in debate ---

[Nicola Blackwood]

As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.

NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.

In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.

The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.

[Ms Abbott]

Is the Minister saying that there is currently no way of making sure that CCGs spend the requisite proportion of their funding on mental health?