Mental Health Act 1983

Julian Lewis Excerpts

Thursday 25th July 2019 Westminster Hall

[Dr Julian Lewis (New Forest East) (Con)]

Thank you, Ms Buck, for calling me so early in this debate. I am sure that I speak for everybody who listened to the remarkable speech of the hon. Member for Bermondsey and Old Southwark (Neil Coyle) when I say that it was a privilege to do so. We should all be immensely grateful to him for illustrating the important policy points that he had to make by means of his agonising experiences in his immediate family in his very early years. We all thank him for it.

Given how many hon. Members wish to contribute, I will speak very briefly. I note that the hon. Gentleman’s speech was briefly interrupted by some shouting outside the Chamber to do with Brexit; it seems to be a common theme that mental health debates tend to happen at times when they are overshadowed by other issues. For example, when I became a Member of this House in 1997, I came second in the private Member’s Bill ballot. I chose to introduce the Mental Health (Amendment) Bill, which was designed to achieve improvements for people who suffered catastrophic breakdowns such that they needed to be admitted to acute mental health units.

At that time, the person who came first in the ballot chose to address a subject of massive national importance, namely the banning of hunting with hounds, and I could not help but notice the contrast between the packed main Chamber on the Friday that was considering the welfare of foxes and the rather more thinly occupied main Chamber a week later, as was customary, when we were trying to consider the welfare of human beings. It was ever thus.

The points at issue then are, to some extent, still points at issue now. They have already been touched upon, at least in part, in the excellent opening speech that we have all heard. My particular concern was the need for there to be separate therapeutic environments for people who had to be admitted to acute units who suffered from very different types of mental illness. In other words, the idea that somebody suffering from acute depression should be cheek-by-jowl with somebody suffering regular psychotic outbursts was obviously a recipe to make a very serious situation even worse.

While I was doing the research for that debate, it was drawn to my attention by staff at acute units that their particular nightmare was the thought of what would happen if there was inadequate staffing coupled with mixed-sex wards. I was really rather shocked and shaken today to hear the statistics cited by the hon. Member for Bermondsey and Old Southwark about the level of danger of sexual assault among in-patients, because for quite a number of years I and various other colleagues waged a campaign to abolish mixed-sex wards in mental health in-patient facilities. At first there was talk of separate bays, if I recall correctly, which by no means would have answered the necessities of the problem. And successive Governments kept saying that they would do it, and even that they had done it, so it is particularly disturbing to hear about the level of concern that still exists about this issue.

The question of inadequate numbers of beds has already been touched upon by the hon. Gentleman. It has to be said that, for once, this is not the responsibility or fault of Government, because after the closure of so many of the large asylums, the pendulum—in my opinion, and I am not an expert; I have to say that I am not a medical doctor—swung too far the opposite way.

I remember, in the New Forest area, having to fight a bitter campaign—which ultimately failed—to prevent a 35% reduction in in-patient beds in acute units. If I remember correctly, two of five units were closed. We were prepared to compromise and say, “Close one of the two units. Close 16 of the beds, rather than 32, and see how you get on,” but the authorities would not listen and they forced the closures through. It was the Southern Health NHS Foundation Trust, which later became notorious in the mental health sphere for other reasons, that forced through the closure of all these beds, and the system has been rammed and overflowing, and under excessive pressure, ever since.

There was another knock-on effect of the swinging of the pendulum too far back from the correct policy of closing the larger asylums, and that was that, by having fewer permanent facilities, we lost the ability to have what was technically—or maybe not very technically—known as the “revolving door”. This was the idea that, yes, if we could get more people back in society, so that they could make their own way and live their lives freely and without having to be in-patients, the very existence of a network of permanent establishments—albeit for other purposes—meant that there were always plenty of opportunities, so that if somebody felt that a trough was coming they could seek help easily for, as it were, almost a top-up of treatment, just for a few days. That would then set them back on track and it meant that they would not suffer—

[Neil Coyle]

indicated assent.

[Dr Lewis]

I am delighted to see the hon. Member for Bermondsey and Old Southwark indicating his agreement. It meant that they would not then suffer a much worse breakdown, which would have meant that they would have to be incarcerated, for want of a better word, for a much longer period.

[Debbie Abrahams]

To prevent people, including people living with dementia, from having to be admitted to hospital, there needs to be community support and after-care support once people are discharged, to ensure that they can be kept as healthy and independent as possible in the community for as long as possible.

[Dr Lewis]

The hon. Lady is absolutely right, as long as we recognise that what is needed is a range of facilities. Even the most ardent advocate of doing away with in-patient beds would, if pressed, admit that there will always be some people who at some point absolutely need to have some in-patient treatment.

If there are some people who need to go in for a considerable period of time, and hopefully there are a lot more people who do not need to be admitted to acute units at all, it follows almost logically that there will be some people who are on the borderline between the two, who can get by in society with a degree of self-awareness—either their own or that of their immediate family—and that when the warning signs appear, provided there is that network of specialist care with beds for very short-term stays, they can receive what I call a “top-up”, or, if we were talking about servicing a vehicle, something that will prevent a much greater collapse from happening later, with all the consequent horrors.

The question of what happens when people are admitted to acute units arose on a second occasion. I mentioned the first occasion, when I tried to introduce my private Member’s Bill in December 1997 and it was overshadowed by foxhunting. On a second occasion—on 9 December 2010, to be precise—I had secured an Adjournment debate on what happens about the information that is given to someone’s nearest and dearest when an adult is sectioned and goes into an acute unit. That occasion was on the day of the key debate about the trebling of student tuition fees, so once again we found mental health being somewhat upstaged by other matters that were of national importance. However, that is no reason not to persist or not to continue to try and emphasise to Ministers how these issues will never go away until they are finally tackled.

On that occasion in December 2010, I raised the case of the daughter of my constituents, Mr and Mrs Edgell. Sadly, their daughter—who was called Larissa but known as Lara—had taken her own life in 2006. For two years prior to that, the medical authorities had refused to share information about her with her parents; because she was an adult in her thirties, they refused to share vital information about her suicidal thoughts with her parents, on the grounds of patient confidentiality.

It subsequently turned out that there were very good guidelines that said that such information should be shared. So, I wrote to the then Minister with responsibility for care services, the hon. Member for Bury South (Mr Lewis), saying that there was clearly a breakdown in the system if adequate rules existed but were not being put into practice locally. The rather unsatisfactory answer that I received at the time was that the responsibility lay with the local medical authorities to ensure that the central guidelines were implemented.

As I say, that was at the end of 2010, so it was a long time ago. I wonder whether the Minister will be able to reassure me that there is now more central direction. In the case of Lara and her parents there was inadequate sharing of vital information, under the mistaken belief that patient confidentiality trumped the fact that an adult patient was incapable of making her own decisions. I would like to know whether that situation has been rectified, or whether we are still dependent on local medical institutions and authorities to apply a central guideline that ought to be better known.

This week, I received a letter from Lara’s mother, who asked me to attend this debate. I can do no better than to read from what she says, not so much about what happened to her daughter but about the continued interest that she has in the workings of the mental health services. She says that she would like to make her own recommendations; given what happened so tragically in her immediate family, we owe it to her to give serious consideration to those recommendations, which are as follows:

“1. The 1983 Act should be revised to prioritise the dignity of individuals who come to be in the Service’s orbit.

2. Such individuals should have their values and world views respected and have a significant say in the manner of their treatment.

3. They should have the option to refuse certain treatments.

4. Mental hospitals must be places where patients feel safe: there have been numerous allegations of staff members being abusive, provocative and/or intimidating.

5. Use of force should be absolutely minimised. This includes physical restraint, seclusion, or forced medication.

6. A reduction in ‘sectioning’.

7. A reduction in stigma”—

and finally:

“8. All aspects of the Mental Health Service should be more open, and subject to independent scrutiny from time to time.”

I will conclude by making one left-field observation relating to the armed forces. The Select Committee on Defence, which I have the honour of chairing, has been recommending for some time that we establish a centre of excellence for the mental injuries suffered by those who put their life on the line to defend this country, preferably alongside the national centre for physical rehabilitation at Stanford Hall. We have now raised this issue twice with the Secretary of State for Health and Social Care, who has given us a reasonably encouraging response. However, once again, we feel that he is coming up against resistance because of the philosophy that people must be treated locally when at all possible, not admitted as in-patients in centralised locations. That is causing a pushback against our idea.

Our idea is based on the fact that those who suffer injury in combat situations have experienced a peculiar and unique form of trauma, different from those that ordinary mental health professionals can be expected to understand. I am sure that my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer) will want to expand on that topic, if he is lucky enough to catch the Chair’s eye. We believe that there is a case for a national centre of excellence, and that the welfare of members of our armed services who suffer mental injury should be no less important to us than the welfare of those who suffer other, physical forms of injury in the cause of defending our freedom.

--- Later in debate ---

[Jackie Doyle-Price]

I cannot give the hon. Gentleman a straightforward answer to that question but I will write to him with a commitment. It is very boring, but Brexit has diverted officials in the Department. Obviously, no-deal preparations in the health service are a matter of public concern, so we need to make them, but we still need to get on with business as usual. It is an important issue.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned the case of Matthew Leahy. I will go away and reflect on that, but I will give the same message as I gave in response to Seni’s law. Generally, we need to get a proper grip on how we learn from deaths that happen when somebody is in the state’s care, because that is clearly unacceptable. We have coronial reports of all those occasions. People should not be waiting the length of time that they are waiting for inquests. When inquests happen, again, there is usually representation from the various institutions involved and the family can be left feeling very under-represented against a mass of organisations trying to avoid liability. We need to tackle that properly.

We have had those discussions at the ministerial board. My ministerial colleagues in other Departments and I want to get a grip on how we properly hoist in the learnings from coronial reports. I look forward to engaging with hon. Members on that, but I will write to the hon. Lady specifically on the issue of Matthew Leahy. It is worth noting that we are looking at the principles of sexual safety in wards, which is not just about getting rid of mixed-sex wards. People are very vulnerable in those situations and it is all about the care regime.

[Dr Lewis]

Can the Minister tell us in simple terms what the situation is regarding the continuation or discontinuation of mixed-sex wards in mental health acute units?

[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

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[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.

[Dr Lewis]

The Minister says that that seems extremely sensible but if, for example, somebody is seriously mentally ill and imagines that their parents mean them harm when they are actually doing everything they can in support, should the parents be locked out from knowing what is happening to their child?

[Jackie Doyle-Price]

We will have to have that debate. My right hon. Friend articulates the opposing position to what I have heard. I regularly hear his example when I chair the national suicide prevention panel. We have had dialogue with NHS organisations and there is a consensus statement setting out the framework by which reports can be given to family members. Equally, patients who are detained under the Act should be able to say which family members should not be consulted about their treatment. For example, we see women who are victims of domestic violence and abuse by their partner and find themselves detained under the Act; their partner would normally be their next of kin, but it would not do those women any good for that person to be contacted.

[Dr Lewis]

I quite agree, but my debate was nearly nine years ago. Is it not a bit late in the day for the Government to say, “Well, we are having a conversation about this?” At the time, there seemed to be some quite sensible rules, but the main problem was that the local mental health authorities were not applying them. If anything, it seems that we are further away from our objectives than we were nine years ago.

[Jackie Doyle-Price]

I think my right hon. Friend misunderstands me. We have a consensus statement that governs how NHS organisations and practitioners should deal with people at risk of suicidality, although there is concern among bereaved families that it is not always followed. Equally, in delivering a service that empowers patients, those patients should be able to identify their nominated person. Those discussions take place much more frequently when people set up new relationships with NHS practitioners. When they change GP, for example, they are invited to nominate a person, in case there are any safeguarding issues.

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[Dr Lewis]

I hesitate to intervene one last time. I fully accept the Minister’s point about abusive partners, but what if the person is desperately, seriously ill and delusional, and the mother is not allowed to be told information about their offspring, because they are technically an adult? At what point do you decide that the person has lost capacity to identify correctly with whom information should or should not be shared?

[Jackie Doyle-Price]

That highlights the importance of having a nominated person earlier in the journey. I do not disagree with my right hon. Friend, but he highlights the difficulty of our work to get the balance right between keeping someone safe and respecting their wishes. I fully anticipate that when we produce the White Paper on this issue, he and I will probably have another debate about it. It is important that we get it right, with the safety of the patient in mind while empowering them to make their own decisions.

I have already mentioned that we will end police stations being places of safety under the Act, and that will be included in any legislation. On equalities, we are working with the NHS to introduce the first ever race equality framework to ensure that mental health care providers work with local communities to improve the ways that patients access and experience treatment. An important point is that although we are concerned that under the Act there are far too many detentions of people from black and minority ethnic communities, it is possible that is partly because they find it difficult to access services. We need to address that properly.

To help to address that, we are also launching a pilot programme of culturally appropriate advocacy. Clearly, we will need to make that resource available to ensure that people have access to it. The review said that we need to learn a lot more about that whole issue, so we will work with the National Institute for Health Research, which will launch a call for research later in the year to give us more answers. Jacqui Dyer MBE is our Mental Health Equalities Champion, and she will play a leading role in taking forward the review’s recommendations on tackling the injustices faced by black and minority ethnic services users.

I have spoken for quite some time; I hope I have covered most of the aspects mentioned. On the issue of funding, I have probably bored everyone senseless by saying that we are determined to deliver a much-expanded service, and our focus must be on developing those community services. We have made resources available to do exactly that through the long-term plan, but that is not to say that the issue is not still challenging. However, I hope we will be able to do much more in the community for people with severe mental illness, so that we can treat them in the community rather than have them go into crisis care.

To illustrate that with an example, if we can get people out of beds and into the community, the ability to look after more patients is really stark, so it starts to pay for itself. I discussed that with a clinical director from the NHS, who said that if they remove three people from in-patient beds and have them in the community, the productivity is so much greater straightaway. We rely on good local leadership to crack that and make it happen.

I have covered most of the things I wanted to. I will just reiterate my thanks to all Members who have participated in a very good debate, and I look forward to having discussions on the White Paper as it develops.

Acquired Brain Injury

Julian Lewis Excerpts

Thursday 9th May 2019 Commons Chamber

[Sir John Hayes]

I will—very much so. I have been terribly unlucky, by the way, having suffered a severe head injury as a result of a road traffic accident and, like the hon. Member for Rhondda, contracted bacterial meningitis. We both speak with some authority on this subject.

The patterns that those families endure are similar, one to another. Initially, of course, there is shock—a sense of disbelief—and the question that most people pose in these circumstances: “Why me?” Then there is a gradual realisation of the depth and scale of the effects of acquired brain injury, and an unhappy initial concentration on what the person can no longer do, followed eventually by a reconcentration on what they can do. Most families follow that pattern when they suffer this kind of event, and that is why all that is done beyond the treatment of the initial trauma is so critically important.

Neuro-rehabilitation is vital because of the dynamic character of these conditions. Most people who acquire a brain injury will change. Many will recover fully and some will recover partly, but all that takes place over a long period and is particular to each case. There is an unpredictability about the effects of acquired brain injury; it can affect physical capacity of course, psychology and cerebral function, as well as personality. Families dealing with that must cope with those kinds of changes, which can be terribly frightening for the individuals concerned and those who love them. The point is that a difference can be made by the quality of care that they receive during that rather difficult journey.

[Dr Julian Lewis (New Forest East) (Con)]

May I add one more category to those listed by my right hon. Friend and the hon. Member for Rhondda (Chris Bryant)? I am talking about service personnel who were blown up in Iraq and Afghanistan, some of whom, although apparently uninjured as a result of the great advances in vehicle technology that enabled them to survive improvised explosive devices, are believed to have been misdiagnosed with post-traumatic stress injury, when in reality they are suffering from mild traumatic brain injury. I believe that only two scanners in the whole country are capable of identifying mild TBI. There is not yet an adequate programme to make sure that the condition is discovered before irreparable damage is done.

[Sir John Hayes]

I am grateful to my right hon. Friend for making that point. The hon. Member for Rhondda talked about the understanding that we need in the welfare system and the expertise that we need to acquire in dealing with the repercussions of a traumatic event. Often, misdiagnosis is part of that problem. Because of the characteristics of acquired brain injury that I described earlier—the changes in personality and the effect on cerebral function—misdiagnosis is all too easy. Part of our mission in bringing the all-party group’s report to the House’s attention, and doing so again in today’s debate, is to get all of Government, including the Ministry of Defence, working together to understand the breadth and scale of the problem. That kind of intergovernmental approach is essential to the recommendations of our report, and I shall say more about it in my concluding remarks.

Before I do that, I wish to say a little about the difference between the initial responses to acquired brain injury, whether acquired through a traumatic event such as a road traffic accident—indeed, many are acquired that way, which is why so many young men are affected—or through the kind of illness that the hon. Member for Rhondda spoke about, such as a brain tumour, meningitis or some other disease. By and large, the initial response is, as is so often the case in the NHS, routinely excellent. People are treated quickly and highly effectively. It is what happens afterwards that is more variable in its effectiveness.

When people leave hospital, invariably having been treated extremely well by our superb NHS, whether their subsequent treatment is effective is a matter of some uncertainty. It can be, and often is; indeed I pay tribute to the good work of Headway—I am a patron of Headway Cambridgeshire and have been for many years—and the other organisations that play a part in supporting families, spreading understanding and sharing good practice, but it is to some degree a lottery. It is partly about where someone lives and how effective the local agencies are; it is partly about how well Government Departments and local government work together and how meaningfully they address some of the challenges that are the inevitable consequences of these kinds of injuries. The all-party group’s report deals with them and the hon. Member for Rhondda highlighted some of them. There are educational effects and effects in the workplace and in socialisation; perhaps there is even the risk of criminality as a result of the consequences of a brain injury. It is the business of neuro-rehabilitation, which we emphasise so strongly in the report, that lies at the heart of what we believe the Government need to do to improve the outcomes for the people and families concerned.

When I was a Minister, which I was for a long time but not for long enough, many people in the House tell me—it is not for me to say, of course—I found that perhaps the greatest challenge Ministers face is in dealing with matters that cut across Departments. It has become almost routine to talk about Departments working in silos, but it is certainly true that the character of the vertical structure of the way we run Government and organise ministerial responsibilities makes it quite difficult for Departments to interact, or sometimes even to interface. On this subject, perhaps as much as on any subject that I know of, it is critical that Departments do just that. We speak in our report of the Departments concerned, and my right hon. Friend the Member for New Forest East (Dr Lewis) mentioned another, the Ministry of Defence. I urge the Government to continue to explore how we can take a cross-departmental approach. We have had strong support from the Cabinet Office, but I hope that the Minister will take that further forward.

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[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I praise the remarkable work of the APPG on acquired brain injury for its dedication to this issue and for securing this particularly important debate. Research from Headway, the brain injury association, shows that every 90 seconds someone in the UK is admitted to hospital with an acquired brain injury-related diagnosis. That is approximately 350,000 people a year. If this debate lasts for an hour and a half, another 60 people will have been struck by brain injury while we are in the Chamber. The majority of those people will need at least some form of short-term support or long-term rehabilitation to help them rebuild their lives, re-learn lost skills and regain a degree of independence.

Excellent work is done in the charity sector to support people with acquired brain injury. I am sure that many colleagues across the House will want to join me in congratulating Headway on reaching its 40th anniversary this year. I am proud to say that the charity is based in my constituency and led by my friend and colleague, Peter McCabe, as chief executive. For four decades, it has been supporting brain injury survivors and their families and carers, to ensure that lives saved by significant advances in neurosurgery are lives worth living.

When a brain injury strikes, it is usually without warning. Put simply, it can happen to anyone, at any time. The support provided by Headway starts from the moment brain injury strikes and continues for as long as it is needed. With the introduction of major trauma centres, the chances are that a patient with a significant brain injury will be quickly transferred to a unit that is better equipped to provide specialist emergency care. That can be many miles from the family home. I am sure we can all agree that, if a loved one were involved in an accident or suddenly became seriously ill, we would want to be at their bedside, but for some people—particularly in low-income families—that can be a challenge if the patient is transferred to a unit many miles away.

That is why I would like to raise the importance of the Headway emergency fund, which provides grants to families to ensure that they can be by the bedside of a loved one in a coma. To date, the charity has distributed more than £369,294 to 1,783 families across the UK. In addition, families can receive emotional and practical support to help them to cope with the overwhelming situation and to make sense of what is happening. They can also rely on the charity’s nurse-led helpline, which has seen an increase in demand of 131% over the last 10 years.

Given that there will be many people watching the debate who are working on this issue, I would like to raise the Headway brain injury identity card, which is endorsed by numerous agencies in the criminal justice system, including the Police Federation and the National Police Chiefs’ Council. The House has previously discussed the high prevalence of brain injury among the offender population. This new initiative from Headway is helping the police to identify brain injury survivors at the earliest opportunity, to ensure that they receive appropriate support.

We should all be proud of our national health service, particularly when it comes to emergency and acute care, but a life worth saving has to be a life worth living. Many of my hon. Friends here today will be aware of the excellent work being done by Headway groups and branches in their constituencies. Whether through rehabilitative therapies to improve speech and language skills or facilitate a return to work or education, or social interaction to prevent isolation, the work being done in our local communities by these groups and branches can be a lifeline to families affected by brain injury, helping people to rebuild their lives and become less dependent on costly state support.

[Dr Julian Lewis (New Forest East) (Con)]

May I add briefly to that catalogue of virtues the fact that Headway has been reaching out to parliamentarians like ourselves? The reason I am here for this debate is that Jo Hillier of Southampton Headway got in touch with me and asked me to be here. That is why I am learning so much more about this condition than I would otherwise have had the possibility of knowing.

[Siobhain McDonagh]

That is my experience as well. Had Peter McCabe not called me, I might not be here, and I would know so much less about the volume of people who experience brain injury and the sort of problems they and their families and carers have.

We are very grateful for Headway’s intervention. However, Headway cannot do this alone. Local charities are under incredible pressure. Funding cuts are causing harm to the lives of some of society’s most vulnerable people, who are being cut out of society due to a lack of access to vital support services. For many people, Headway provides a route back to independent living, further education or employment. The reality is that, aside from Headway, most people—particularly those who cannot afford private healthcare—will receive insufficient support or rehabilitation after leaving hospital. Unless action is taken to enable people to access the vital support needed to ensure that these services survive, more and more people will be cut out of society and taxpayers will be left footing the bill for the longer-term care of those without the means to care for themselves. Considering that another four people will have been struck by brain injury during my speech, there simply is no time to delay.

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[Seema Kennedy]

My right hon. Friend makes an extremely important point, showing that this is an issue not only for the health system and my Department but for others across Government.

While the majority of rehabilitation care is locally provided, NHS England commissions specialised services for patients with the most complex levels of need. For people who have ABI, neuro-rehabilitation that is timely and appropriate is an important part of their care. Access to high-quality rehabilitation improves outcomes for patients and can save money. The shadow Minister mentioned rehabilitation prescriptions. RPs reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient and are an important element of rehabilitation care. The APPG report was clear that all patients with ABI should benefit from an RP.

NHS England’s major trauma service, where acute phase rehabilitation begins, sets out that patients should be reviewed by a rehabilitation consultant. The shadow Minister asked about this. The development of major trauma centres, which the hon. Member for Rhondda supported, has improved recruitment to this specialty, while the national clinical audit of specialist rehabilitation recommended that all trauma networks review access to rehabilitation consultants and make improvements. Patients should have either a rehabilitation consultant or an alternative clinician with skills and competencies in rehabilitation to provide an initial formulation and plan to complete and perform the initial RP. At discharge, all patients should have a patient-held record of their clinical information and treatment plan from admission as they move to specialised or local rehab.

The “National Clinical Audit of Specialist Rehabilitation for Adults Patients with Complex Needs Following Major Injury”, published in 2016, found that on average 81% of patients had a record of a rehabilitation prescription. The audit recommended that MTCs take action to improve compliance. The audit report appears to have had a significant impact. The latest data, from the last quarter of 2018, from the trauma and audit research network shows that the national average rose to a 95% completion rate for RPs. This is good news. NHS England has worked with patients, clinicians and charities to improve the RP design and set new standards for communication and involvement of patients, families and carers. It is hoped that the new RP will support the development of a rehabilitation dashboard to monitor the performance of the system. Audits play an important role in helping services to improve. The report also recommended that all organisations within a trauma network work together to review capacity.

The majority of rehabilitation care is commissioned and managed locally. To support commissioners to plan services for local populations, NHS England has produced a document, “Principles and Expectations for Good Adult Rehabilitation”, that describes what good rehabilitation looks like. Additional guidance covering adults and children sets out a commissioning model and the evidence base for delivering high-quality rehabilitation services.

The hon. Member for Rhondda mentioned that ABI spans many Departments, and I shall take away all the comments that concern my ministerial colleagues and will ask them to respond. On support for children with ABI in school, the special educational needs and disabilities system is designed to support all children and young people with additional needs. The arrangements for SEND are intended to support joint working between health, social care and education; multi-professional assessment of a child or young person’s needs involving relevant experts; and the development of an individual education, health and care plan to meet those needs. This should provide a basis for the sharing of information and expertise to ensure the needs of children and young people with ABI are supported in school.

The hon. Member for Blaydon mentioned the ABI card. The Department for Education has said that promotion of the card is a matter for individual schools, but as far as my Department is concerned, Professor Chris Moran, a national trauma director, said that he would be happy to promote the card in trauma networks, working with the Brain Injury Trust. The statutory guidance on supporting children with medical conditions at school covers a range of areas, including the preparation and implementation of school policies for supporting pupils, the use of individual healthcare plans, consulting with parents, collaborative working with healthcare professionals and staff training. The Department for Education continues to work with organisations such as the Health Conditions in Schools Alliance to help to raise further awareness of the duty on schools.

On prisons, there is an increasing body of evidence linking ABI to offending behaviour. NHS England’s liaison and diversion service has collaborated with Headway to develop workshops to improve awareness and identification of ABI in vulnerable offenders and the support available. The “train the trainer” workshops were designed so that attendees could return to their services and cascade workshop learning to their colleagues. Representatives of all NHS England-commissioned liaison and diversion services attended. Over the past two years, the Ministry of Justice has also piloted approaches to improve screening and support for prisoners through new link worker roles at six sites on the male secure estate. I take the point about female offenders and will speak to the relevant Minister. There was a pilot at a female prison between 2016 and 2018, but I will take away the point about the female estate.

I want briefly to touch on the point raised by my right hon. Friend the Member for New Forest East (Dr Lewis), the Chair of the Defence Select Committee. The veterans trauma network delivers comprehensive medical care to veterans, including those suffering from brain tumours, and, as he knows, the Prime Minister opened the successor Defence centre to Headley Court last year. We do not recognise his statistic that there are only two machines, but I will take that away and report back to him.

[Dr Julian Lewis]

I was not talking about tumours; I was talking about traumatic injury caused in explosions. My understanding is that only Nottingham and Aston Universities have the special types of scanners that can detect that particular injury. Will the Minister check that point and consider a screening programme for such people?

[Seema Kennedy]

I will happily take away that challenge from my right hon. Friend and will write to him.

The hon. Member for Rhondda spoke passionately about sport, although he claims not to be a sportsman. It is important that we do more to reduce the risk of ABI in sport. The Department for Digital, Culture, Media and Sport asked Baroness Grey-Thompson to carry out an independent review of the duty of care that sport owes to its participants; her report dedicated a chapter to safety, injury and medical issues. National governing bodies are responsible for the regulation of their sport and for ensuring that appropriate measures are in place to protect participants from harm. The DDCMS expects everyone in the sports sector to think carefully about the recommendations in Baroness Grey-Thompson’s report and in the all-party group’s report. Progress has been made over the years, for example through the Rugby Football Union’s Headcase campaign and action by other groups.

It is important that the welfare system appropriately supports people with ABI. Work capability assessments for the employment and support allowance are conducted by healthcare professionals for the Centre for Health and Disability Assessments. Case discussions about claimants with ABI form part of new entrant training for all healthcare professionals who undertake such assessments. They should all have access to a self-directed learning module on ABI, which was updated in 2018 and quality-assured by Headway.

Since September 2017, those who are placed in the ESA support group and the universal credit equivalent, who have the most severe and lifelong health conditions or disabilities and are unlikely ever to be able to move into work, will no longer be reassessed. Changes have been introduced so that existing claimants with the most severe lifetime disabilities whose functional ability has remained the same are more likely to have their evidence reviewed by a Department for Work and Pensions decision maker, and not need a face-to-face assessment with a healthcare professional.

I hope that this debate demonstrates how seriously the Government take the issue and the devastating impact that it can have on people’s lives. We are committed to ensuring that people are better protected. I look forward to responding to further debates.

Appropriate ME Treatment

Julian Lewis Excerpts

Thursday 24th January 2019 Commons Chamber

[Sir David Amess]

I am taken by the fact that we have two former Secretaries of State sitting together—my right hon. Friend the Member for Putney (Justine Greening) and my right hon. Friend the Member for Loughborough —and I certainly listen well to their advice. I absolutely agree with what my right hon. Friend says.

My constituent goes on to say:

“I do not understand why we are not being believed. I had a promising life, two beautiful boys and a career I loved. I didn’t choose to be this ill with no hope of any treatment, compassion or cure.”

The overwhelming experience of sufferers is a struggle to be believed. There is a lack of understanding among the public, policy makers and, most worrying of all, the medical profession.

[Dr Julian Lewis (New Forest East) (Con)]

My constituent Rachael King told me that one area in which there has been understanding is in schools, saying that Noadswood School and Brockenhurst College in my constituency are very understanding indeed. However, she says that her 15-year-old daughter Larissa is one of the luckier ones in that respect, because so many people are not believed, as we have heard today. If they were not depressed by the condition, they will be depressed as a consequence. However, ME is not depression; it is a serious illness in its own right.

Gosport Independent Panel: Publication of Report

Julian Lewis Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

First, I again pay tribute to the role that the right hon. Gentleman played. One of the most difficult things for any Minister is knowing when to accept advice, which is what we do most of the time, and when to overrule it. His instincts have been proved absolutely right. It is not an easy thing to do, and it causes all sorts of feathers to be ruffled, but he stuck to his guns, and rightly so. Bishop James Jones, who is a truly remarkable public servant, talked in the Hillsborough panel report about the

“patronising disposition of unaccountable power”.

That is what we have to be incredibly on guard against.

The right hon. Gentleman is right: at the heart is the problem that we did not listen to families early enough and we did not listen to whistleblowers inside the NHS early enough. My reason for saying that all these things need to see the sunlight of transparency much sooner is frankly that if they had come to light sooner and if proper attention had been given to this in 2001—we all know that Mid Staffs started in 2005—how many other lessons and tragedies throughout the health service could have been avoided? That is why I think it would be the wrong reaction today to say that we are getting there on patient safety and that transparency problems are solved: there is a lot further to go.

[Dr Julian Lewis (New Forest East) (Con)]

Within the last few hours, I have learned that I have a constituent whose grandmother had recovered from successful hip surgery without the need for any drug interventions and was sent to Gosport War Memorial Hospital for rehabilitation, only to be given a lethal cocktail of drugs that killed her. The matter was reported to Gosport police when it happened in 1998. Does the Secretary of State agree that if people are found wilfully to have administered lethal drug doses unnecessarily, they deserve to lose their liberty, and that if people are found wilfully to have covered up such crimes—for that is what they are—they deserve to lose their jobs?

[Mr Hunt]

I think everyone in the House would share my right hon. Friend’s sentiments, but we have to let the law take its course, and we have to make sure that justice is done, because it has been denied for too long.

Breast Cancer Screening

Julian Lewis Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We will look at whether we are able to get in contact with people and will get in contact whenever we can, but there is of course a helpline through which anyone can contact us. It is also important to say that, according to the advice I have received, missing the final screening will in many cases not make a difference to a patient’s cancer or the treatment they receive, but we will do everything we can to support everyone who thinks they might have been affected.

[Dr Julian Lewis (New Forest East) (Con)]

While it will be for the review to investigate and report on why the fault with the algorithm was not discovered earlier, can the Secretary of State throw any more light on the circumstances in which it eventually came to be discovered? He said, for example, that it was in the course of a computer upgrade. Obviously, the circumstances that led to its discovery could be a pointer towards greater safeguards for the future.

[Mr Hunt]

That is a very good point. The original issue—or the original potential issue—was identified by people working on the AgeX trial for Oxford University, who then brought it to the attention of Public Health England in early January. One of the issues seems to have been the confusion about whether the scans stopped when someone turned 70 or whether they should carry on until their 71st birthday. That is why we think the original coding error happened, but obviously this is a matter for the review, and we need to learn everything from it.

Surgical Mesh

Julian Lewis Excerpts

Thursday 19th April 2018 Commons Chamber

[Owen Smith]

My hon. Friend is right. The whole point of mesh is that it is designed to induce scar tissue in order to fuse the mesh with the muscle, and therefore trying to excise the mesh is incredibly difficult. That is why there are partial removals and some women are left with pieces of mesh inside them, even after surgery. Those sorts of complications are clearly very worrying. They ought to have been explained properly to women, but obviously were not, in very many cases.

[Dr Julian Lewis (New Forest East) (Con)]

The hon. Gentleman is making an excellent speech, and I thank him for his work. Will he go back to what he said a few moments ago about the idea of it being acceptable that 1% to 3% of cases might go wrong? It might be acceptable if we are dealing with a small overall total, but when we are dealing with over 100,000 cases, we are saying that it is acceptable for 1,000 to 3,000 people to suffer devastating, life-changing injuries as a result of this procedure. Surely that is anything but acceptable.

[Owen Smith]

It absolutely is not acceptable. I hope that the Minister is not going to repeat what other Ministers have said in written statements and in this place, which is that 1% to 3% is the sort of failure rate, or complication rate, that one would expect with all sorts of surgery. The reality is that the numbers are far greater than that—far, far greater—as the audit this week shows. I will come on to address that.

--- Later in debate ---

[Dr Julian Lewis (New Forest East) (Con)]

I start by saying that I think the steps taken in Scotland, as described by the hon. Member for Glasgow North (Patrick Grady), sound extremely sensible as interim measures until final decisions can be taken. I echo the thanks due to the hon. Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Pontypridd (Owen Smith), their associates in the all-party group, and Sling the Mesh campaigners. I also thank my three constituents, Emma, Eileen and Helen, who have all shared with me their harrowing experiences of the procedure.

There is no doubt that when vaginal mesh procedures go wrong, the results can be truly catastrophic. A letter from the Minister states clearly that

“women have suffered atrocious and debilitating complications”

from these implants. Her counterpart in the Upper House, Lord O’Shaughnessy, has conceded this:

“While these treatments can be effective, in a small minority of cases meshes can cause serious long-term injury and disability, and prevent or reduce the ability of affected women to work.”

According to a letter from the Health Secretary to parliamentary colleagues in February:

“Clinical experts here and abroad agree that, when used appropriately, many women gain benefit from this intervention, and hence a full ban is not the right answer.”

I find it difficult to follow that logic. There might be an acceptable argument if we were talking about a procedure in which the numbers of interventions were in the hundreds, but, as I said in an intervention and as the hon. Member for Pontypridd (Owen Smith) endorsed, we are talking here about over 100,000 people. When we are talking about over 100,000 people, if even the Government’s low figures of 1% to 3% going badly wrong are right, that is still 1,000 to 3,000 people. I have been given, by my constituent Emma, a leaflet from Sling the Mesh that says that its estimate is that at least 15% of people are seriously and badly affected. On that scale, we are talking about over 15,000 people being seriously damaged by this procedure.

[Owen Smith]

I thank the right hon. Gentleman for giving way and for his kind remarks. Would he be surprised to learn that the chief medical officer, Dame Sally Davies, speaking alongside the Health Secretary in a Facebook Live broadcast just a few months ago, said that she thought the serious complication rate was between 15% and 20%? I have written to her asking where she got those numbers, although as far as I am aware she has not replied to me, because that is at odds with all the previous comments by Ministers and officials.

[Dr Lewis]

Indeed. I would be surprised at that, because if that is what Dame Sally believes she ought to be making different recommendations.

I have been given a particular study, which is described as the largest study of surgical mesh insertions for stress urinary incontinence. Over 92,000 women were surveyed in this particular examination, including all NHS patients in England over an eight-year period. The conclusion states:

“We estimate that 9.8% of patients undergoing surgical mesh insertion for SUI experienced a complication peri-procedurally within 30 days or within five years of the initial mesh insertion procedure. This is likely a lower estimate of the true incidence.”

I reiterate my point about acceptable and unacceptable percentages. When we are talking about these very large numbers, even relatively low percentages make the procedure too risky to be used in anything other than last-resort circumstances similar to those described by the hon. Member for Glasgow North.

In the past decade, my constituent Emma has undergone X-ray-guided injections, ultrasound scans, MRI scans, in-patient stays, tests galore, more and more scans, and, eventually, a biopsy. She has been refused referral to a mesh specialist centre. It seems highly likely that she should never have been given a mesh implant in the first place after the trauma of such a difficult birth, which leads me to the next point about inadequate warnings. I understand from my constituents that they were given little warning, and in many cases no warning at all, about the potential dangers.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

My right hon. Friend is making some very important points. Does he agree that prevention is better than cure? If physiotherapy were offered to women after childbirth, that might obviate the need for any surgery at all as a result of these kinds of complication.

[Dr Lewis]

Indeed. The problem with this issue, as it has been impressed on me at any rate, is that this has been put forward as a quick-fix alternative to other procedures, whether surgical or not, which would take much longer.

Having paid thousands of pounds for private specialist assessment, in the end Emma eventually managed to get the sort of referral she wanted. I have been given the following clinical summary of her condition:

“Vaginal mesh; foreign body giant cell reaction, chronic inflammation and fibrosis.”

I have a page here that lists some 50 different symptoms related to implant illness and foreign body giant cell reaction. I venture to suggest that if this ghastly catalogue of things that could go wrong had been shown in advance to those 100,000-plus women who have had a mesh implant, more than 90% of them at least would have turned it down.

This is what my constituent Eileen wrote to me:

“The effect that this has had and is still having on my life is massive. I can no longer carry out basic tasks at home or do things with my children due to the pain. I need to take medication every day from my GP to try and ease the pain. I cannot go to work at present due to the pain and I am currently on sickness absence leave from my job. The mesh implant that I have had has and is continuing to destroy my life. I need an operation to remove the mesh implant, but the operation is very complex and unfortunately there are limited amounts of surgeons who are experts in the full removal of these mesh implants. Due to my financial situation, I am not in a position to be able to afford to have the full removal of the mesh implant done privately and therefore I am having to wait for this to be done on the NHS which is taking far too long.”

I turn now to Helen, who probably has the most horrifying story of the lot. She was 35 when given what was described to her as routine surgery 16 tortured years ago. She was initially told that it was her fault that her body was rejecting the two mesh implants. She then went through a cycle of implants, the removal of protrusions and eroded segments and seven bouts of surgery. Three TVTs—trans-vaginal tapes—are still inside her, she suffers chronic pain from orbital nerve damage, constantly needs painkillers and has had constant side effects, indifferent treatment and a refusal to admit fault or to refer her to an out-of-area specialist in mesh removal. She writes:

“I do not want anyone from the hospital coming near me ever again. I have lost complete faith in them. I have been lied to and told repeatedly it was my body rejecting the mesh; but, unbelievably, they kept putting more in.”

She suffers from truly terrible bowel problems, some no doubt caused by the side effects of the painkillers and the sleep aids she has to take. Consequently, she suffers from depression, loss of confidence and lack of self-esteem. She further writes:

“I feel let down by professionals who were supposed to treat me to the best of their ability. There has been information about the adverse effects of mesh around for years, yet these doctors are still happily inserting them into thousands of women.”

She is desperate to be referred to one of the few doctors who specialise in mesh removal and feels trapped under the control of the very people who have let her down. She continues:

“I want these devices out of my body.”

Who can blame her?

Let me conclude by quoting, from an article in The Daily Telegraph of 23 October last year, a lady who suffered for eight years:

“I just wish I had never, ever had it done. I would rather have coped with that very minor problem of stress incontinence than this. If I had known even one of the possible risks of the surgery there is no way I would have had it done. I am furious that I was never told that this could happen.”

--- Later in debate ---

[Jackie Doyle-Price]

I can absolutely give the hon. Gentleman that assurance. It is crucial that we address the matter transparently—that is very much the spirit in which I want to take this forward.

[Dr Julian Lewis]

Before those interventions, the Minister said that if people are still not getting adequate treatment, it should be brought to her attention. As I mentioned, I have been contacted by constituents saying they felt trapped because the people who did the procedures were refusing to refer them elsewhere for a second opinion and for possible help from the very small number of people who specialise in the rectification and reversal of these procedures. What advice can she give my constituents about how to break out of this restriction on being referred to people in whom they can have more confidence?

[Jackie Doyle-Price]

I listened carefully to my right hon. Friend’s representations on behalf of his constituents, and they filled me with alarm, because we have given a clear indication on this point and have established 18 specialist centres to deal with the consequences of mesh. There is, therefore, no excuse for patients who require further intervention not being properly referred. Perhaps he and I could take this up offline to make sure his constituents get the support they deserve.

I want to put this in the context of our broader emphasis on patient safety. We have learned, through difficult experience, that there is never one measure or magic bullet to suddenly transform services for patients; it is about sensible dialogue between patients, clinicians and sometimes politicians—sometimes we can have a role in catalysing the debate. We all need to pull together to tackle all aspects of the issue. In some respects it is about the actual product—the vaginal mesh—but it is also about clinical practice and behaviour, as we have talked about. The most important thing, however, is the need to listen to patients, who, in this context, are of course women. We have to make sure that we listen to women when concerns are raised so that we can properly tackle those concerns as they arise. As I have said before, I am concerned about informed consent for patients, but the issues go much further, and generally we could do much to improve the performance of the NHS by placing a greater emphasis on that.

We need to consider the whole issue of clinical advice. We know that this product should not be routinely offered as a first intervention, yet clearly it is. I am horrified to hear of women in their 20s and 30s being treated with this product, when clearly it is not intended for them. It is obviously easy for me to make a superficial judgment on that without knowing about the particular cases, but on the face of it, it seems quite wrong.

The issue has been raised of what is an acceptable level of risk. I do not like to think about that in terms of percentages, because the acceptable level of risk will differ from patient to patient. If we are talking about some new mums, the level of risk clearly would not be outweighed by the benefits, but if we are looking at women suffering from horrendous conditions of incontinence, that is a very different debate. Again, we need to think about the broader issues. It all comes down to making sure that the guidance is properly applied and that clinicians who are recommending the use of mesh are properly making that assessment in discussion with their patients.

There has been a demand for a public inquiry. We have introduced the Cumberlege review, which is designed to make sure that we properly assess the interests of patients going forward. I know that many patients have felt that their views have been ignored. Baroness Cumberlege is very keen to hear directly from individual patients about their experience, and will be going round the country to do exactly that.

I could say much more, but I must conclude so that we can move on to the next debate. I will write to hon. Members, who I thank for contributing to the debate, to address some of their other points. We are determined to do our best for women who have been badly treated in having this procedure.

Cyber-bullying: Young People’s Mental Health

Julian Lewis Excerpts

Monday 16th April 2018 Commons Chamber

[Alex Chalk]

The hon. Gentleman rightly raises a really important point. It is only recently of course that revenge porn has become a criminal offence, but I dare say there is more that could be done. It is just one aspect of the hinterland of cyber-bullying but an extremely important one to raise.

[Dr Julian Lewis (New Forest East) (Con)]

My hon. Friend is doing us tremendous service by bringing this topic to the House. To what extent is anonymous bullying a factor? We all know from before the age of the internet the devastating effect of poison pen letters, even on a small scale; here one can have anonymised poison pen electronic letters that are accessible worldwide. Is it people who are known to victims mainly or is it people sheltering behind anonymity?

[Alex Chalk]

That is an extremely good point. In truth, it is both, and not only is it the nature of the bullying but the volume. Social media provides the opportunity, whether through sham accounts, spoof accounts or whatever, to multiply the torment, so my right hon. Friend raises such an important issue.

The most striking thing of all perhaps was that 83% of the young people told our inquiry that they thought the social media companies should do more to tackle this scourge. They felt that the onus was on the victim to act—to block or delete—and that reporting all too often felt like shouting into an empty room. There is a perceived lack of consequences for those who engage in bullying behaviour online in a way that is different from real life. There is some evidence from some platforms of temporary sanctions for cyber-bullies to nudge them back to good behaviour, but they remain the exception.

In fairness, the message is starting to get through. In his new year 2018 message, Facebook founder, Mark Zuckerberg, vowed to “fix Facebook”. One of the priorities he highlighted was “protecting our community from abuse and hate”, and he admitted that enforcement of house policies was failing. I am afraid we concluded that he was right. It is particularly impactful and devastating when the people who are being affected are under the age of 18. They are just children.

While we were grateful for the constructive engagement of social media companies—and it is true to say that the larger companies tended to take the issue more seriously—the unavoidable overall impression was that announcements and measures were largely tokenistic: slow and inadequate. Because there was so little transparency about the number of reports and the nature of the response, it was, in effect, impossible to determine whether the resources allocated bore any relation to the scale of the problem. The companies essentially continue to mark their own homework. As one witness put it, companies faced with growing alarm about the implications for young people’s mental health are “walking backwards slowly”. That is not acceptable, because our evidence showed that those failures have an impact on children and young people, and that the effect is particularly profound, concerning and long-lasting.

It is important to emphasise that tackling cyber-bullying must be a joint endeavour. Parents, guardians and teachers all have a role to play, but it is equally true that when it comes to minors, social media companies bear responsibility as well. It is simply not enough to sign children up and then just let them get on with it. It is important for the companies to be age-appropriate, and to do more to identify under-13s and, when appropriate, gain explicit consent from parents or guardians. They should provide timely, effective and consistent responses to online bullying, and they must become more accountable. What do I mean by that? I mean that they must publish data about their responses to reports of online bullying. Only then—if we know the number of reports, and the nature and timeliness of the responses—will any sensible assessment of the efficacy of those responses be possible.

As for the Government, I think that they ought to do what they reasonably can to improve our understanding of the role of social media in adolescent mental health. We are very much in the scientific foothills of our understanding of these issues, and the firmest possible evidence base will help to tailor the best solutions. I recognise, however, that the Government have gone a long way with the digital charter to increase the tempo, and I urge them to continue that important work.

My final comments are thanks. I thank the young people—more than 1,000 of them—who responded to the inquiry and gave evidence, and without whom the report would have had no currency. It was their evidence that gave its conclusions their heft, and it was their experience that left such a marked impression on all who took part in the inquiry.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank my hon. Friend the Member for Cheltenham (Alex Chalk) for securing this timely debate on the important issue of the effects of cyber-bullying on young people’s mental health. He articulated extremely well the challenges that we need to tackle, and I agreed with much of what he had to say about them.

I pay tribute to my hon. Friend for the report that was published recently. As he said, 1,000 young people participated in the inquiry and produced a useful body of evidence from which to draw conclusions. I also thank the Children’s Society and YoungMinds for their role in the inquiry. I met representatives of YoungMinds today, and I have regular dialogues with them on the broader issues relating to the mental health of children and young people. They are very important partners for us in this context.

As my hon. Friend recognised, a number of Departments have an interest in this matter. I have often said that silo culture is the enemy of good policy making, and I am pleased to say that the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport are all approaching the issue from their own unique perspectives, and attacking it from different angles. We are all committed to tackling the scourge of cyber-bullying, although, as my hon. Friend pointed out, it is an emerging issue that requires careful consideration of the evidence and joint working to enable us to start stemming the flow. He was right to say that we need to draw conclusions in a timely way to ensure that we have the appropriate tactics for prevention.

It is important to recognise that the term “cyber-bullying” is often misleading. We are talking about two separate elements. Bullying is a kind of behaviour that can take many forms, and social and other cyber-media are tools for that bullying. As my hon. Friend and my right hon. Friend the Member for New Forest East (Dr Lewis) have said, this has become a particularly acute problem to tackle as those tools can be anonymous. That dehumanises both the bully and the victim, and if we do not get it under control more effectively it will become the epidemic my hon. Friend has warned of.

Turning to what the Government are doing, the Department of Health and Social Care is focusing on improving services for children and young people’s mental health. We know that children and young people’s mental health services need to improve, and we have a programme of work under way, supported by more than £1.4 billion of additional funding, to achieve just that. As my hon. Friend the Member for Cheltenham will know, the Department of Health and Social Care and the Department for Education recently published a joint Green Paper on children and young people’s mental health, which was supported by a further £300 million.

Through that Green Paper, we acknowledged the potential impact of social media and the internet on children and young people’s mental health, but, most significantly, we identified that effective mental health care for young people does not have to take place in a clinical setting. That reinforces the importance of getting the right support in schools, which underlines my hon. Friend’s priority of preventive measures. That is why we are placing much more support in and around schools, where young people spend so much of their time.

We are also taking action to use the digital world to our advantage, using positive digital interventions for mental health. For example, NHS Digital is producing an apps library that brings together a number of digital tools to help improve health, including mental health and wellbeing, for all ages. Over time, many more tools will be added to the library to support more health needs and drive up quality.

Turning to the online world, where I think my hon. Friend is more interested in holding other agencies to account, the Department for Digital, Culture, Media and Sport last year published our internet safety strategy Green Paper. A response to the consultation process will be published imminently, and I am sure my hon. Friend will be first in the queue to read its conclusions. It will include a number of preventive initiatives to tackle cyber-bullying so that all users of all ages feel confident in being online. For example, during the consultation we proposed a voluntary social media code of practice. The intention is for the code to provide guidance to platforms about how they should tackle abusive behaviour and content and support all users, because adults can be bullied just as much as children on social media platforms.

I personally think the providers can do a great deal more. My hon. Friend referred specifically to Facebook. While Mark Zuckerberg’s comments to which he referred are welcome, I think a lot more can be done. Given that reporting to social media companies is low among those who recognise that they have been cyber-bullied, and that children have little confidence in social media companies to resolve cyber-bullying, the internet safety strategy Green Paper also involved consultation on annual online safety transparency reporting by companies. That reporting is intended to both develop better understanding of the extent of bullying behaviours and encourage those who are being bullied to make referrals to those companies. Social media companies must do more to raise awareness and improve the clarity of their reporting mechanisms in relation to cyber-bullying, and we hope that improving transparency reporting will help improve the likelihood of young people reporting these issues in the future.

As I have said, however, this is not an online-only issue, and the Department for Education is taking action to prevent bullying in general as well as cyber-bullying. All schools are legally required to have a behaviour policy with measures to prevent all forms of bullying. The Government have already put in place a number of powers and a range of support to enable schools to prevent and tackle cyber-bullying. For example, headteachers have the power to regulate pupils’ conduct when they are not on school premises. Where bullying outside school is reported to teachers, it must be investigated and acted on. We have also ensured that schools have the power to ban, limit the use of, or search mobile phones in school, and the Government Equalities Office funded the UK Safer Internet Centre to develop cyber-bullying guidance for schools and an online safety toolkit to help schools deliver sessions about cyber-bullying, peer pressure and sexting. I can advise the House that the Department for Education is also providing £1.75 million of funding over two years to support schools in tackling bullying, with cyber-bullying being an integral element of that.

Returning to the role of social media companies, we really believe that they have a central role to play. That is why we set up a joint working group with the Department for Digital, Culture, Media and Sport to discuss how to make progress in specific areas, particularly that of age verification. My hon. Friend said that many young people are spending a great deal of time online—more than was good for their health—and we want to explore time limits. On the question of age verification, I am clear that the social media companies could do a lot more to protect young people. The reality is that if they can collaborate on developing apps that allow people to harvest data, they can use the intelligence on their platforms to identify young people and communicate with them. We recognise that some companies have existing work in place, and we congratulate them on that, but a lot more can be done. There are significant challenges to overcome, and there remains a need for further action to be taken. We are actively encouraging companies to work with us and to make tangible progress in this area.

We have heard what the Government are doing to tackle these problems as they arise, but we also need to recognise that, without further research, our efforts will not reach the level that we need and that young people deserve. We have heard the statistics already this evening. Social media and the internet are an ever-growing part of children’s and young people’s lives. As my hon. Friend has said, some individuals are spending an inordinate amount of time online. More than half of 12-year-olds have a social media profile, and those are the people who really need our protection. However, although evidence has shown links between increases in social media use and poorer mental health, it is not clear whether that increased use causes poorer mental health, or whether poorer mental health drives an increase in use of social media. We need to develop more evidence on that.

We should also recognise that there are positive impacts of social media use that can really improve the lives of children and young people suffering with mental health issues. It can build a community that they can access to increase their self-esteem and get social support. In practice, that could mean children collaborating on projects through better online communities—for example, a homework WhatsApp group for people in the same class or a Twitter hashtag for those studying for school or university exams. So let us keep a balance here: there are some positives. Young people also take advantage of being able to access supportive online networks of people with similar health conditions, which could be more difficult in the offline world.

I should also like to welcome the Science and Technology Committee’s recently launched inquiry into the effects of social media on young people’s health. I am sure that my hon. Friend will be watching that with interest too. I look forward to contributing to the inquiry and to hearing its outcomes, which will add to our evidence in this area. I can also advise the House that, in order to better understand the relationship between social media and the mental health of children and young people, the chief medical officer is leading a systematic review to examine all relevant international research in the area. For the review, existing literature will be searched extensively, which will enable Professor Davies to build a map of research activity, identify the areas for in-depth review and subsequently allow her to examine the areas in detail. This will allow her to assess the relative strengths and weaknesses of the evidence base, as well as considering the positive and negative impacts of social media.

In conclusion, across Government, we are as clear as my hon. Friend is about the need to take action to tackle and prevent the increase in cyber-bullying, as well as the need to improve the support available to those suffering as a result of it. We are incorporating such action within related work streams across the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport. It is clear that a cultural shift is needed to ensure that future generations do not accept cyber-bullying as the norm, and that they know when and how to access support and help. We need to make it clear what online behaviour is acceptable and what is not. We have made it clear as a Government that we are prepared to work with social media and technology companies in this area, and, like my hon. Friend, we expect them to take significant further steps. However, the buck stops with them. The ball is in their court and they need to do much more. We will continue to maintain the dialogue on that basis. I thank my hon. Friend again for raising this important issue. I have no doubt that we will come back to the subject again.

[Dr Julian Lewis (New Forest East) (Con)]

On a point of order, Mr Speaker. With the blessing of the Government Whip here present, may I ask whether any steps have been taken to reinstate the curtain-and-commode system that used to envelop the Chair, so that on occasions like today, when you have sat there continuously from when the House first met until the House adjourns this evening, you might be able to do so in a little more comfort?

[Mr Speaker]

Well, I am grateful to the right hon. Gentleman for his point of order, but I am not aware that any such steps are planned. In so far as my personal comfort is a matter of interest or concern to the right hon. Gentleman, which is very touching, and might conceivably be to other colleagues, I can assure him and them that I have not felt other than comfortable, privileged and exhilarated to have been in the Chair for the past nine and a quarter hours.

Question put and agreed to.

NHS Staff Pay

Julian Lewis Excerpts

Wednesday 21st March 2018 Commons Chamber

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

rose—

[Dr Julian Lewis (New Forest East) (Con)]

rose—

--- Later in debate ---

[Mr Hunt]

I disagree that the deal will not be believed—it is a concrete deal. NHS staff still have to vote for it, but the Government have committed to significant rises in pay. I agree, however, that we will need to find the best way of getting more money into the NHS and social care system as we face the pressures of an ageing population.

[Dr Julian Lewis]

Will the Secretary of State expand a little on what he briefly said about flexibility of working hours and family bereavement among NHS staff? After this urgent question, will he kindly give a short tutorial to those of us with an interest in defence on his successful techniques for extracting £5 billion from the Treasury for a Department that urgently needs it?

Contaminated Blood

Julian Lewis Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

As I mentioned, no firm view has been taken as to which Department will run the inquiry, but as the Minister with responsibility for this area the House would consider it amiss if I were not having meetings and discussions with those affected about the inquiry’s remit. When the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), made the statement to the House about the inquiry, we made it clear that we wanted to progress as soon as possible. The Secretary of State called this meeting because we want to hear directly from the victims about what they want from the inquiry. We are very much in listening mode. A decision has not yet been taken as to which Department will run the inquiry but ultimately, as a Minister, I am accountable to Parliament for what happens in the Department of Health in those areas for which I have responsibility, and I want to be leading from the front, having those discussions.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for saying that no decision has yet been taken about which Department will run the inquiry. Does she agree that perception is as important as reality in this matter, and therefore will she gain from this occasion a mindfulness of the weight placed by hon. Members, on both sides of the House, on the idea that the inquiry perhaps would be perceived to be more objective if some other Department took the lead?

[Jackie Doyle-Price]

I say to my right hon. Friend, and I have repeated this in other discussions as well, that the Cabinet Office is very closely involved in this, and this opportunity has given me the time to make that clear to the House. The Government are listening; we want to consult as widely as possible. No decision has yet been taken, but the Cabinet Office is closely involved in all the consultation we are currently having.

Contaminated Blood

Julian Lewis Excerpts

Tuesday 11th July 2017 Commons Chamber

[Mr Dunne]

I have just described the additional contribution to the financial scheme for England. It will be for the inquiry to decide whether it wants to make recommendations about financial arrangements. At present, I am not in a position to give the hon. Gentleman the confirmation that he is seeking. That will have to come through the inquiry.

[Dr Julian Lewis (New Forest East) (Con)]

My constituent Lesley Hughes was infected with hepatitis C in 1970, but this was discovered only about three years ago. Will any consideration be given to those long years of suffering when the compensation scheme is put into effect?

[Mr Dunne]

I offer my sympathy to my right hon. Friend’s constituent for the challenges she finds herself facing. We have to say at this point that it will be down to individuals to make their applications. We will respond to the consultation in due course. I strongly encourage my right hon. Friend to make representations on his constituent’s behalf to the inquiry when it is established.