The National Health Service

Kevin Brennan Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move an amendment, at the end of the Question to add:

“but respectfully regrets that the Gracious Speech does not repeal the Health and Social Care Act 2012 to restore a publicly provided and administered National Health Service and protect it from future trade agreements that would allow private companies competing for services who put profit before public health and that could restrict policy decisions taken in the public interest.”

I am grateful to the Leader of the House for finding time to schedule this important debate. I associate myself with the condolences and sorrow expressed about the horrific tragedy in Essex. I pay tribute to all the emergency services, who must have had to confront the most unspeakable of sights in Essex in the past 24 hours.

In a similar vein, I pay tribute to our hard-working national health service and social care staff, who every day go beyond the call of duty, going the extra mile for each and every one of our constituents, ourselves and our loved ones. They do it after a decade of cutbacks and of the tightest financial squeeze in the history of the NHS, but despite that, our NHS staff are treating more patients every day than ever before. I am afraid, however, that we have a Government who are still expecting our staff to deliver care in the most intolerable working conditions, from bed cuts to staffing shortages and equipment breaking down every day. The dismal consequence of this decade of underfunding and cuts sees patient care suffering and standards of care deteriorating.

Let me share a couple of examples with the House. Somebody from another part of the country got in touch with me and asked me to raise this directly with the Secretary of State, although she asked that we anonymise these exchanges. Her 91-year-old mother fell in her house on a Sunday at around 2.40 pm. She waited two and a half hours for an ambulance. When she got to the hospital, she waited an hour and a half in a cold corridor before being admitted to a bay. Eight hours later, she was seen by a doctor, who recommended an X-ray and scan. She got the result of the X-ray at 1.15 am. Only then was she given pain relief and put on a drip. By 3 am, she still had not been admitted to a ward. At 9 am, she was sent back to her care home—her daughter was not told—with no pain relief or any prescription.

Perhaps I can tell another heartbreaking story, from today’s edition of Pulse. It reveals that a teenage boy—a 16-year-old—was referred to child and adolescent mental health services by his GP, but because his condition was not considered serious enough, CAMHS turned him away. The boy later died by suicide. These are heartbreaking stories, but stories like that are happening far too often in a health system that is under intense pressure.

[Kevin Brennan (Cardiff West) (Lab)]

My hon. Friend is telling tragic stories about the impact on real patients of what is happening in the NHS. Other families who are suffering are those often with children who have very severe conditions, such as epilepsy, who would benefit from access to medical cannabis. The Government have indicated that that access should be available, but it is just not getting to these families, and the children and families are suffering, both because of the pain and financially as a result. Does he agree that the Government should do much more to fast-track availability?

[Jonathan Ashworth]

I completely agree, and I pay tribute to my hon. Friend and to hon. Members such as the right hon. Member for Hemel Hempstead (Sir Mike Penning) who have led the charge in this debate. If medicinal cannabis has a medicinal, therapeutic value, it should be allowed. If there are issues in the bureaucracy that are slowing it down, and if that needs legislation, we will work with the Secretary of State to get it through, if that is where the blockage is. If the blockage is in some other area and he needs our co-operation, we will co-operate with him. We need to resolve this, because too many young people are going without the help they need.

Medical Cannabis under Prescription

Kevin Brennan Excerpts

Monday 20th May 2019 Commons Chamber

[Kevin Brennan (Cardiff West) (Lab)]

I congratulate the right hon. Gentleman and my hon. Friend the Member for Gower (Tonia Antoniazzi) on the work they have done on behalf of the all-party parliamentary group on medical cannabis under prescription, and on behalf of my constituent Bailey Williams and his family. His mother has written to me about today’s debate, which unfortunately she cannot attend, to say that Bailey really needs urgent access to medical cannabis because of the continuing effect that his constant seizure activity is having on him. Does the right hon. Gentleman feel as frustrated as I do that, many months after the Government first indicated that this medicine could be prescribed, he is still having to speak about it today and I am once again having to raise Bailey’s case on the Floor of the House?

[Sir Mike Penning]

I thank the hon. Gentleman for his intervention. That is what we are here for. Yes, we are frustrated and angry, but actually we are here to do something very important. The only reason the Home Office deregulated this drug and we are in this position today is that this House came together and, more importantly, because the families came together. Those families have young children—I am a father myself, like lots of colleagues in the House—and we all came together to say that the situation was fundamentally wrong. We asked why medical cannabis was illegal if we knew that it helped our children.

--- Later in debate ---

[Jeff Smith (Manchester, Withington) (Lab)]

Forgive me for shuffling my papers, Madam Deputy Speaker; I was not expecting to be called quite so early in the debate. I am grateful to have been called early, but the House will have to bear with me. I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi) on securing the debate, on their brilliant campaigning on this issue and on their co-chairpersonship of the all-party group on medical cannabis. I also congratulate the campaigners—some of whom are present—who have brought this issue into the public eye over the past year and are determined to make sure that it remains there.

[Kevin Brennan]

Like my hon. Friend, I thought that my hon. Friend the Member for Gower (Tonia Antoniazzi) might have been called next, as the co-chair of the all-party group—I think that is probably what was in his mind—and I was going to intervene on her to correct my earlier intervention, because I see that my constituents Rachel and Craig, who are Bailey Williams’s parents, have managed to attend today’s debate, despite the fact that they thought they would not be able to because of a medical appointment for Bailey. This gives me the opportunity to pay tribute to them for their relentless campaigning on his behalf. It is because of people like them that we are all here this evening.

[Jeff Smith]

I am delighted to have given way to my hon. Friend to allow him to pay that tribute to our visitors today.

I have received two letters from a constituent of mine, who has asked me to keep his name confidential. I am happy to give it to the Minister on a confidential basis. My constituent first wrote to me on this issue last September, after the Government accepted the principle that we should be able to prescribe medical cannabis, because the aim had not been fulfilled. He wrote:

“I have a grandson who suffers from a severe form of Crohn’s disease. He is in constant pain and finds that his present regime of opiate-based pain killing has difficult side effects. He tells me that his consultant doctor is willing to prescribe the cannabis-based alternative as soon as it is permitted. My grandson has never obtained cannabis illegally and does not intend to do so.”

My constituent wrote again to me in April. Things had moved on, but this probably illustrates the problem. In the second letter, he wrote:

“The position in my family is now relatively fortunate. Left in limbo for a long time by the NHS, and enduring frequent nausea and serious debility, my grandson used his own initiative. He found a private doctor specialising in pain control, a highly respectable man, formerly an NHS consultant, who gave him a prescription for a cannabis product. This has been successful. His symptoms are under control, his general health and capacity to eat are much improved, and he is being phased back into his job, which he had been likely to lose. I am meeting the financial cost to the tune of £695 per month currently. By tightening my belt I can do it, at least for a reasonable time to come. I never spent money to better effect in my life, and I am so grateful for medical science. But some of the sufferers on the TV programme have no financial resources. And for an old Socialist like me it goes against the grain to use private medicine.”

Madam Deputy Speaker, you do not need to be an old socialist to think that this is an unacceptable situation.

--- Later in debate ---

[Jeff Smith]

My hon. Friend makes an excellent point. Yes, there may be risks, but we should look at the risks of some of the other treatments that people are using. Opiate treatments are much more risky than cannabis.

We need to find another way forward. We need to take into account the different types of evidence. We need, really, a bespoke medical response to this. I ask the Minister, how can we use the different types of evidence to get an evidence base that will satisfy Government and satisfy clinicians? How can we use, for example, the Access to Medical Treatments (Innovation) Act 2016? We also need a bespoke regulatory response. The question for the Minister is, why not? Other countries have done this, such as the Netherlands, Germany and Canada. They all treat cannabis differently from other products and other treatments. Holland has set up an office for medical cannabis to deal with the complexity of the issue and I do not see why we cannot do something similar.

[Kevin Brennan]

To follow up on the excellent point made by my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle), in many of these instances, as with my constituents, we are talking about children who are suffering multiple seizures that are impacting on their mobility, weight and muscle tone through muscle wastage, and this is putting their lives at risk. Is it not therefore quite strange that the balance of risk does not seem to be taken into account when considering prescribing this treatment?

[Jeff Smith]

That is absolutely right. There is almost an irrational fear about the risk of cannabis compared with the risk of some of what we might call more conventional treatments that people are already using.

Access to Medical Cannabis

Kevin Brennan Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

We looked at observational trials, but the problem is that they do not build the evidence base that a full RCT does. A full RCT also allows some patients to get access while the trial is ongoing, so it is in fact a better proposal. It means that some patients can get the treatment now for the purposes of the trial, and then we can get a full evidence base for the long term, as was mentioned previously.

[Kevin Brennan (Cardiff West) (Lab)]

The law may be an ass, but it does not have to be applied in an asinine way, as it was in the case of Emma Appleby. Will the Secretary of State have words with the Home Secretary to make sure that it is not repeated? My constituent, Bailey Williams, is 16 years of age and suffers from the most severe form of epilepsy. He has multiple seizures every day. His parents, Rachel and Craig, are absolutely convinced that we need observational trials and more immediate action. I accept that this was unintended, but sadly the change in the law has made things worse, not better, for those parents. What will the Secretary of State do to turn that around quickly?

[Matt Hancock]

It is a source of deep frustration to me that the change in the law to normalise the use of medicinal cannabis has, exactly as the hon. Gentleman says, meant that, because a clinical decision is needed for a prescription, and because in many cases clinical decisions are not forthcoming, many parents who entirely understandably think that their child would benefit from medicinal cannabis now find that they cannot get a clinician to sign it off. That is at the root of the problems that we are trying to tackle today.

Services for People with Autism

Kevin Brennan Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

I certainly do. The challenge is to ensure that care plans are flexible enough to be built on, while also including an element of prescription so that there is a proper guide. What must not happen is plans being effectively reneged on when care and support are still needed. The hon. Gentleman made his point very forcefully. He also said that I was doing a good job reading the speech; I will carry on doing my best.

I was talking about the impact on services, as my right hon. Friend the Member for Chesham and Amersham puts it,

“from education to adult support, from diagnosis to employment, transition to transport. We know the many ways that an autistic person may turn to the state—and to us—for support, and how vital it is to make sure it is there to meet their needs.

The last national strategy ‘Think Autism’ in 2014 included wide-ranging actions. This was underpinned with revised statutory guidance, setting out clear duties on councils and the NHS to deliver on these actions—but we know that many local areas are not meeting all of their obligations. There are also questions about whether the Act goes far enough. As we reach the 10th anniversary of the Act, now is an appropriate time to ask these questions.

The All Party Parliamentary Group on Autism, which I am proud to chair, is spending this year doing just that. We are holding an inquiry into what has worked, what happens now and, most importantly, what needs to change. We are looking very broadly, to reflect the needs of autistic people,”

including in health and mental health; children, education and transition; employment; access to justice; adult support; and public understanding.

[Kevin Brennan (Cardiff West) (Lab)]

I welcome the APPG’s inquiry, and, in particular, the fact that it will look into the way in which adults with autism interact with the criminal justice system. I think that is an area in which the work of the Act could be extended. I pay tribute to the families who set up an organisation called Autism Injustice, and recommend its website, autisminjustice.org, to other Members and to people watching our debate who are interested in that interaction between autism and the criminal justice system.

[Huw Merriman]

The hon. Gentleman has referred to adults, but I remember going on a trip with the APPG to a young offenders institution that had tried to establish a wing that was autistic-friendly, and hoped to roll it out across the estate. He is right: a big cohort of the prison population are on the spectrum, and face particular challenges that need to be looked at.

--- Later in debate ---

[Kevin Brennan (Cardiff West) (Lab)]

May I, too, congratulate the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan), who, sadly, cannot be here because of that family situation, on her speech? I also congratulate the hon. Member for Bexhill and Battle (Huw Merriman). I think he would agree that he proved that, as the old song says, there’s nothin’ like a Dame, but he did an admirable job in delivering her speech and in answering interventions from colleagues from across the House.

I take an interest in this subject, as do many Members, through constituency casework, and I have particularly focused on adults with autism. Understandably, there is often a lot of debate about children with autism, but those children grow up to be adults, and often many of the difficulties can arise when that cliff edge comes and children with autism become adults. Sadly, this often ends up with adults with autism coming into contact with the criminal justice system, as happened in the case of one of my constituents, whom I will not name for obvious reasons. The trait of stimming is shared by many people with autism, but it is not generally understood by the general population. It is the repetitive behaviour of some with autism in order to calm a situation, but it can be misinterpreted sometimes as a criminal action. In the case of my constituent, that led to his being arrested on two different occasions by the British Transport police when he became nervous travelling on public transport. This ended up with his being inappropriately cautioned and that remaining on the record, despite the fact that that caution was later withdrawn, in recognition of the fact that he had not been given the appropriate support that adults with autism are supposed to get when they come into conjunction with the criminal justice system.

[Tonia Antoniazzi]

What has been highlighted is that travel is also traumatic for people with autism. Will my hon. Friend join me in congratulating Cardiff airport on training its staff to support children and adults with autism when they are travelling through the airport?

[Kevin Brennan]

I absolutely join my hon. Friend in congratulating Cardiff airport on that. Going through an airport, with its security and everything that comes along with it, is a stressful enough situation for anyone, so the fact that the airport is doing that is very much to be welcomed.

Lord Bradley, a former Member of this House, produced a report in 2009 on how not only people with autism but other individuals with mental health issues come into contact with the criminal justice system. At the end of last year, he and I, along with some families of adults with autism, arranged to meet the new head of the new Independent Office for Police Conduct to talk about the way the police often deal with adults with autism when they come into contact with them, and with the complaints that then come when those adults with autism have been treated inappropriately and not according to the guidelines originally envisaged by Lord Bradley back in 2009.

Michael Lockwood, the IOPC’s new head, is to be given some credit for engaging seriously with this issue. We can see a sea change in attitude on this issue from the new IOPC when compared with the former Independent Police Complaints Commission. For example, he has agreed to meet and engage with the families of those who have had cause to raise complaints with the IPCC and the IOPC, and to involve them in designing the ways in which the IOPC will respond. There is a recognition that often these sorts of inquiries can be confrontational, whereas what is really needed is to get to the heart of the matter and the truth, and to make sure that lessons are learned and spread throughout the criminal justice system, particularly in the police force.

One thing that is being done by the IOPC, which I welcome very much and think should be done in other organisations, is that it is recognising that employees in these organisations will often have children with autism or relatives with autism, and that they can bring some expertise to the organisation when they are interacting with those with autism. For example, the IOPC recognises that many members of its staff are from families that have experience of autism and that they can bring an expertise within the organisation when looking at these cases where complaints are raised. I welcome that, because that sort of learning is what needs to take place across the police, the courts, the prison system, adult and children’s services across the country, and the NHS.

My hon. Friend the Member for Bristol West (Thangam Debbonaire), who is no longer in her place, was talking earlier about what was going on in Bristol. In the case of my constituent and a couple of other families, I welcome the fact that, as I understand it, adult services in Bristol have agreed to review some of the cases they have dealt with in recent years, with a view to publishing a report, appropriately anonymised, that can provide lessons learned to people right across the country. That is very much to be welcomed.

My constituent has got together with other families to help set up an organisation called autisminjustice.org. I recommend that Members look at the stories on the site about the way in which these families have come into contact with the criminal justice system. The organisation’s long-term aims are to ensure:

“That criminal justice and care professionals are aware of and follow existing guidelines and policy relating to autistic people in a way that properly safeguards them.

That these professionals, as well as the general public, understand autism so that autistic people’s appearance and/or behaviour is not misunderstood and misrepresented in a way that puts them at risk of serious harm.”

Those are very laudable long-term aims.

I appeal to the Minister to engage with those families, with that organisation and with other Departments across Government to make sure that government is working in a joined-up way on this. Those of us who have been Ministers understand that it is not always easy to get out of the ministerial silos that Whitehall imposes upon us, but government works best when Ministers from different Departments get together with a common purpose. Surely on this issue of all issues, where there is cross-party support in this House and general agreement on what should happen, we should in no way be inhibited by Ministers not being able to work together. I urge the Minister to do as much as she can to work across Whitehall on this issue.

Autism

Kevin Brennan Excerpts

Thursday 29th March 2018 Commons Chamber

[Kevin Brennan (Cardiff West) (Lab)]

Somebody on Twitter recently asked which film made in Hollywood best bears watching over and again. Of course, I answered “Groundhog Day”. Sometimes, when we have such debates, it can feel a bit like groundhog day, because the same sorts of issues are repeated over and again. What is really important is that they generate some raising of awareness, which they do, and action from the Government.

I hope that having listened to today’s debate the Minister will take away some of the issues that have been raised and try to turn them into some sort of Government action. Hon. Members have been right to raise a number of issues, including that of exclusions, which was mentioned by the hon. Members for Henley (John Howell) and for Cleethorpes (Martin Vickers). What is disappointing is that if we look at the statistics, we can see that exclusions were dropping in the noughties. As an ex-Minister, I can tell hon. Members why they were dropping: they were given serious attention at the centre of government and there was a real grip on bringing down the rate of exclusions, both permanent and temporary, for all children, including children with autism.

One problem—although I understand why the Government did this—of atomising our schools system by making them more and more independent and bringing in accountability measures that encourage sometimes perverse and unethical actions from headteachers is that, in my view, it leads to a rise in exclusions. It is generally thought better to get someone out of the way when the Ofsted inspection comes along, as the hon. Member for Henley said, or to have them excluded from the school if they would bring down the GCSE results. That is unethical, especially without a system in place for those children to be properly educated elsewhere. I appeal to Ministers to look very carefully at what is happening to those exclusion statistics and to get a grip of them from the centre.

It is understandable that the focus of most of the debates on autism tends to be about how it impacts on children. That is completely understandable, but we must not forget, and many hon. Members have not forgotten, that autism does not cease to be an issue when someone turns 18 and becomes an adult. Many of the services that might be available to children with autism fall away when they become adults. Parents get older and it is often more difficult for them to cope. Adults with autism face a complex world when they leave full-time education, if, as we hope, they have not been excluded from it, and the behaviours and traits associated with autism are often poorly understood, misinterpreted and sometimes even mistaken, as we have heard, for criminality.

A key problem is the difficulty in ensuring that services are joined up across the Government—across the Department of Health and Social Care, the Ministry of Justice, the Attorney General’s Office, the Home Office, the Department for Work and Pensions and the Department for Education. We had a debate on this very subject on 30 January in Westminster Hall, and it was suggested by a Government Member—I thought it was a very good suggestion—that the Government, with Cabinet Office oversight, should create something like the armed forces covenant and veterans board to ensure that every Department has someone focused on autism and its impact on families. In my experience, as a former Minister, to get Departments working together and to make progress, we need to get Ministers involved. Ministers have to be brought together, not just officials. It is possible to make significant change by ensuring ministerial leadership and bringing Ministers together across the Government.

The Minister will be about the third Minister to respond to a debate on autism that I have participated in recently, and I hope that she will go away and talk to other Ministers to ensure that they are thinking about how they can work to bring Government policy together on tackling the issues around autism. I hope that she will take seriously the suggestion from a Conservative Member in a recent debate that they should bring together a board or working group of Ministers from different Departments across the Government to tackle some of these issues with ministerial leadership.

When I spoke in that Westminster Hall debate at the end of January, I focused on how adults with autism were affected by the criminal justice system. That has also been mentioned by the chair of the all-party parliamentary group on autism, the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan), and I very much welcome her call for evidence to the group. I encourage other hon. Members to respond. I will certainly do so, and I will encourage my constituents to participate as well.

Some of the behaviours associated with autism, such as stimming—the repetitive physical movement that helps to reinstate a sense of calm in people with autism—are often misunderstood. This is particularly the case for a constituent of mine when he is in a crowded public space or travelling on public transport. When adults on the autistic spectrum come under suspicion of criminal behaviour, safeguarding becomes absolutely crucial, and I referred to that constituent’s case in the Westminster Hall debate. The safeguards in the criminal justice system did not protect him as they should have done under current policy and practice. His stimming was misinterpreted while travelling in crowded conditions on public transport, and that led to his arrest.

I appeal to the Government to look specifically at what happens to adults with autism when they come into contact with the criminal justice system and to find ways to ensure that the police—particularly the British Transport police—are properly trained and that all the services know how to deal with autistic people when they are arrested. I hope that Ministers will consider setting up that joint group. I do not expect her to commit to that today, but I hope that she will commit to taking the idea away and considering it further with other Ministers and reporting back to the House at an appropriate time, so that our debates do not just become groundhog day.

Autism Community: Mental Health and Suicide

Kevin Brennan Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

[Kevin Brennan (Cardiff West) (Lab)]

Does the hon. Lady agree that mental health issues for adults with autism can arise out of the way in which they are treated when they encounter the criminal justice system? The behaviours that sometimes accompany autism can be misinterpreted by people in the criminal justice system. Does she agree that we need not only to get the health provision right but to ensure that the people working in the criminal justice system understand about autism and take it into account when they meet adults with the condition?

[Dr Cameron]

Yes, I wholeheartedly agree with that point. I have personal clinical experience of that through working across a variety of secure hospitals and prisons in my practice with the NHS. People with autistic spectrum disorder often find themselves caught up in the criminal justice system, which has little awareness of their needs or of the support that they require. When they get caught up in the system, it is difficult for them to move on and rehabilitate because the provision simply is not there.

--- Later in debate ---

[Mr Jones]

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

[Kevin Brennan]

I am grateful to my hon. Friend for giving way, because I know that time is short. Does he agree that those Cabinet Committee-style discussions should involve ensuring that the Ministry of Justice and the Home Office understand the ways in which people with autism come into contact with the criminal justice system and understand the behaviours—such as stimming, which is often misinterpreted and ends up with people being arrested—that those individuals exhibit?