Melbourne Declaration on Diabetes

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 18th June 2014 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is, as usual, a pleasure to serve under your chairmanship, Dr McCrea, and it is a pleasure to follow the hon. Members for Torbay (Mr Sanders) and for Strangford (Jim Shannon). The hon. Member for Torbay, in particular, has been making a superb contribution across this entire policy area for many years. As someone who is also “blessed” with type 1 diabetes, I look to him for inspiration, and he readily provides it on a regular basis. I cannot thank him enough for introducing a debate in this House on this subject yet again. His work as chair of the all-party group on diabetes, as president of the Parliamentarians for Diabetes Global Network and in the Global Parliamentary Champions for Diabetes Forum is commendable. His position and work there mean that the UK can be a world leader in ensuring high-quality treatments and support for those with diabetes. I am very sincere in all those comments. They are heartfelt.

The hon. Gentleman spoke on this subject in April, in a debate to which I contributed. He raised some very important issues, not least of which was the importance of an approach that respects the distinction between causes and treatments of type 1 and type 2 diabetes. In opening today’s debate, he has again raised matters of the utmost importance and concern, which I will also touch on.

The Melbourne declaration on diabetes was formally adopted on 2 December 2013, as we have heard, at the first Global Parliamentary Champions for Diabetes Forum. The declaration contains eight action points for parliamentarians, including encouraging the creation and adoption of a national plan that acknowledges that diabetes is a national health priority and that leads to action. I will focus my remarks today on the need to create an action plan. I hope that the Minister, whom I welcome to her place, can confirm that the Government are committed to that, especially given the clear will of parliamentarians from those parties that have contributed today, although I know from discussions and conversations with colleagues right across the House that there is a clear understanding of the need to support an action plan as a way forward.

There are more than 380 million people with diabetes in the world, and that figure is expected to reach almost 600 million by 2035. That is deeply worrying. In the UK, 3.2 million people are living with diabetes. That includes almost 35,000 children. One pound in every £10 spent by the NHS is spent on treating diabetes and the complications that arise from it. We have heard an awful lot about the economic and financial modelling of the effects of diabetes on the NHS. I think that we need to spend more time on that as a country. Diabetes UK says that diabetes is responsible for 20,000 premature deaths each year, and that 80% of cases of type 2 diabetes could be prevented or delayed. Let us just think about that: 80% of cases could be prevented or delayed. The financial savings that we could make, irrespective of the improvements that we could make to the lives of those people who go on to develop type 2 diabetes, are phenomenal.

We must always be aware of the distinction between type 1 and type 2 diabetes. Type 1 is a chronic, life-threatening condition that affects 400,000 people in the UK, including 29,000 children. Type 1, as we have heard, is not caused by lifestyle factors such as obesity, lack of exercise or poor diet. I should know, and I never resist the temptation to remind people that I did the London marathon earlier this year. Thanks go to the Juvenile Diabetes Research Foundation, if its representative is in the room. I want to do it again next year, by the way. Whereas those with type 2 diabetes can sometimes be treated with a change in diet and exercise and modest medication, those with type 1 diabetes need multiple insulin injections or pump infusions every day. I did mine before the debate started. My blood glucose level was 14.7, which is not particularly good—I will be getting told off for that.

Each year, a person with type 1 diabetes will undertake more than 2,000 finger-prick blood tests, have 1,500 insulin injections and count the carbohydrates in more than 1,000 meals. It is clear that any action plan will have to develop coherent and effective strategies for both conditions. A one-size-fits-all strategy simply will not do, so I hope that the Minister can reassure us today that she will not be cutting corners. Any plan must be workable and tailored to meet the specific needs of both conditions.

Diabetes UK has done excellent work, as always, on this matter. Its briefing in advance of today’s debate was superb. It endorses the view that there is a clear need for a national action plan. It has identified five key areas that must be included. Those are improvement in support for self-management; integration of care; improving safety; a focus on children and young people with diabetes; and prevention of type 2 diabetes. I am sure that if the Government introduced a comprehensive action plan built on those five principles, it would receive the support of the entire House.

Starting with self-management, it is obviously crucial that individuals and their families can successfully manage their condition, and the keystone of that is effective care planning and education. Positive care planning and strong education can ensure that an individual is equipped with the tools and resources needed effectively to manage their condition. Diabetes UK calculates that each year, care in a clinical setting totals about three hours, whereas self-care accounts for almost 9,000 hours. Improving self-management is not optional—it is absolutely essential. I appreciate that it could be culturally difficult for us to achieve that as a Parliament and a country, but it is something we absolutely need to crack.

Opposition Members have long advocated the benefits of integrated care across the whole NHS. With diabetes, a person will routinely have contact with many parts of the wider health care system, such as primary, community and secondary care. To improve integration, Diabetes UK has identified five key points that would, in effect, provide an integrated diabetes care pathway. Such a pathway would require strong networks of clinicians, commissioners and patients, a more integrated system of commissioning services, better information-sharing across services and the improving of skills in primary care, all of which should be overseen by effective clinical governance. Those actions are not out of reach, and the Government could easily ensure that they are part of any action plan.

The third point I want to cover is patient safety. There are major issues regarding the safety of in-patients with diabetes in hospitals. According to research undertaken by Diabetes UK relating to the past year, about 40% of in-patients experienced at least one medication error, more than a fifth experienced one or more hypoglycaemic episodes and fewer than a third were seen by a member of the diabetes team. Those problems can, as the hon. Member for Torbay said, contribute to patients with diabetes having to remain in hospital more than three days longer than patients without diabetes. Again, we should consider the cost implications for the health service in these tough times. Any plan the Government introduce must surely address that, because it is bad for patients, clinicians and the health service.

There must also be space in the Government’s plan to address young people’s experiences. There are 35,000 children with diabetes in the UK, which has the fourth highest number of children diagnosed with type 1 diabetes in Europe. Many children and young adults experience a marked deterioration in their care as they make the transition from children’s to adults services. Adolescence is often a time when many lifelong behaviours are established, including those that are health-related, so it is essential that young people can complete the transition at a time that is right for them. A deterioration in care and a forced transition have been shown to disengage young people from the service, resulting in worse outcomes and complications. There is an acute need to address that.

In the last debate on this issue, in April, I referred to support and education for young people, which are key to ensuring that they can manage and cope with their condition. Being diagnosed with any form of diabetes can be overwhelming if the proper support is not in place.

My next point relates to a focus on preventing type 2 diabetes. Recent reports by the British Medical Journal have shown that a third of adults have higher than normal blood glucose levels, which is an indication of pre-diabetes, and many health professionals project that there will be a huge increase in the numbers of those with type 2 diabetes. I am sure that that worries policy makers on both sides of the House, whether on the left or the right or in the centre. As I said, any action plan must take into account the differences between type 1 and type 2. Critically, any strategy for type 2 must be based on prevention.

I would be grateful if the Minister could outline what the Government are doing on the points I have raised, and I would expect her to be able to give us some indication of when they are likely to introduce a plan to address the issue. Given the importance of such a plan, I hope she will make a statement to the House when any plan is published, to give Members who are not present the chance to scrutinise the Government’s proposals. Indeed, I would go further. Every time we have such a debate, it strikes me that there is a real wealth of experience and understanding of these issues across the House. It would, therefore, be a tremendous gesture—not for its own sake, but from the point of view of those living with this condition—if Members who understand type 1 and type 2 diabetes were allowed to contribute their knowledge and experience to the production of a better plan that would better suit those with this condition.

Through the Melbourne declaration, the International Diabetes Foundation makes the incredibly important point that

“disadvantaged people in every country carry the greatest burden”

with regard to diabetes. That is important when looking at the levels of clinical care for diabetics across clinical commissioning groups throughout England. Speaking to diabetics around the country, I have seen for myself that if we are to make self-management as effective as it can be—we have a long way to go on improving not only the culture but the clinical ability of CCGs and other primary care providers regarding self-management—we must make a concerted effort to look at the literacy and numeracy of some of the people with this condition. Every day, before every injection, people must undertake a fairly simple and routine mathematical calculation of their insulin to carbohydrate ratio, but many of them simply cannot do the maths. There is no assistance, tool or device on the market to help them make those calculations simply, so we need to look at that, because it is a big cultural issue. There is an issue with not just numeracy, but literacy, and there are also issues about social exclusion, which I am sure we are all aware of. We need to put some time and effort into understanding and resolving those issues if we are properly to increase self-management among diabetics.

NHS England published “Action for Diabetes” earlier this year, but Diabetes UK said that it was not sufficient and did not present a comprehensive strategy or action plan. I have read it, and I think that is a fair comment. Diabetes desperately needs a national service framework—there are no two ways about that. The service around the country is incredibly patchy when it comes to not just the nine key diabetic tests, but other diabetic support services. Perhaps the Minister can tell us how the Government will ensure that CCGs step up to the plate. We really need a detailed plan, and I hope she can tell us when one will be introduced.

Will the Minister also tell us how many diabetics are missing their checks? That information should be understood and collated centrally, because the issue is of strategic national clinical importance. What are the clinical and financial effects on the service of people missing their appointments? We are failing people with diabetes, and that did not begin in 2010.

I touched earlier on self-management, which is incredibly important, but so are innovation and the use of data. For me as a type 1 diabetic, the most important issue in managing my condition is having access to data about it, such as my blood glucose readings and my insulin ratios. We need a framework and a strategy for medical innovation that incorporates diabetes research—from not just a scientific point of view, but a patient’s point of view—in a profound way. How can we become the best country in the world, in terms of medical companies and other pharma-based industries developing new and innovative ways of treating diabetes?

I wear all sorts of devices to monitor my fitness and my sleep—whether it is a Jawbone, a Misfit Shine or a Nike fuelband, believe me, I have them all. The data they capture about the individual is of incredible medical importance. We need, on a cross-party basis, to establish a strategy under which this country can genuinely innovate and become a global leader, with a view to enabling companies to produce the best suite of devices, applications and so on to assist in dealing with type 1 and type 2 diabetics. I look forward to the day when my data can be captured in real time and shared with my GP and my pharmacist, so that I do not have to phone up, text or e-mail to get my insulin prescription. My GP and my pharmacist will have the information and the algorithm, they will know when my prescription needs to be ready and how much I am using, and my doctor will know how I manage my condition. We can hothouse innovation—my office and I are doing an awful lot of work on this—but we need to make that innovation part of not only a national diabetes strategy, but a biotech and medical innovation strategy.

Finally, I say to the Minister that we are here to help. Will she please use the experience that exists across the House and not miss this opportunity to act?

[Dr William McCrea (in the Chair)]

Before I call the Minister, I want to mention that several Members have apologised for not attending because they are taking part in another debate. They wanted to be here and asked me to pass on their apology to the hon. Member for Torbay (Mr Sanders) and the Minister.

--- Later in debate ---

[Jane Ellison]

I want to discuss another area in which we can make a difference by empowering patients. Colleagues might be interested to hear about the patient experience of diabetes services survey, part of the national diabetes audit, in which I know there is always great interest in the House—we regularly answer a number of parliamentary questions about it. The survey measures the health care experiences of people with diabetes in England and Wales. It collects information online from people with diabetes by asking questions about their care using a short, validated questionnaire, and it is being tested.

Any diabetes service in England and Wales should be able to use the survey to get feedback from patients. We want to publish the first results this month or this summer. That is going to be an interesting extra tool in the box, not only to help to drive excellence and drive out variation, but to empower local services to understand at a local level what is going on and how satisfied their patients are with the service being provided. That can lead only to upward pressure to improve services, not least from patients.

Let me talk a little about the NHS health check programme. Alongside the work being done by NHS England to improve the management and care of people with diabetes, the Government are working on prevention and earlier detection, which all Members mentioned. We are continuing to roll out the NHS health check programme, which identifies those aged between 40 and 74 who are at risk of diabetes and other vascular diseases and helps them to reduce that risk. More than 15 million people are currently eligible for an NHS health check. Our economic modelling has shown that the programme has the potential to prevent more than 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is all about helping people to better manage and improve their quality of life.

In the past year, almost 3 million NHS health check offers were made and almost 1.5 million appointments were taken up, during a time of great change across the health system. We are now looking to challenge the system to go further and faster and to continue to increase the number of people who participate in the programme. I have been out and about and seen some great local initiatives. I visited an NHS health check team in Southwark and witnessed the important conversations they were starting with people in their local area.

Another example is Bolton, where health trainers have worked with 134 people identified as being at risk of diabetes through the NHS health check. The health trainers have supported people to make lifestyle changes such as eating more healthily and increasing physical activity levels, and they have helped almost half the group to return their glycaemic level to normal. That is really good evidence of effective intervention.

In Tower Hamlets, where more than 50% of the population are from ethnic minority groups, the prevalence of type 2 diabetes has been growing rapidly. To help to combat that, Tower Hamlets has incorporated the health check programme into its managed practice network scheme. I have talked to staff about that and heard about how they are approaching it. Tower Hamlets has worked hard to ensure that all diabetic patients have a care plan, and that focus has resulted in a 70% increase between 2009 and 2012. There has also been a lot of focus on the take-up of retinal screening for people with diabetes, and, again, there has been a significant rise.

We are seeing that such local interventions can really work. I firmly believe that a localist approach is important in some of these areas, because there is no one-size-fits-all approach that we can devise in Westminster that will work for every community. Such local innovations are important. I constantly challenge myself to think about how we can ensure that we spread the word about some of this great local action. We have started initiatives in that regard, but Parliament has a great role to play, and I encourage Members to tell us of effective local initiatives, so that we can spread the word.

Research on the NHS health check programme carried out by Imperial college London and Queen Mary university of London is under way. That research will improve our understanding of who is taking up the opportunity, their risk of cardiovascular disease and the incidence of diseases such as diabetes in those groups. When that work comes back, it will help us to understand how we can make those interventions count more.

We have already talked a little about obesity and sedentary lifestyles. Physical activity is a big priority of this Government, and I have had a couple of meetings in the past couple of days alone on the cross-Government action we are taking to try to hardwire physical activity into all aspects of life. We have a long way to go yet because, for too long, physical activity was left in a silo marked “health” when it is more important than that. We know that all parts of local and national Government need to address inactivity; that is one of the factors that can help to prevent diabetes.

I also want briefly to address the responsibility deal. The Government have been working with business—the hon. Member for Strangford mentioned this—on its responsibility to consider calorie reduction and clearer labelling of food. We are starting to see calories and other contents displayed on the packaging of many more foods, as we roll out consistent food labelling on a voluntary basis across the country.

The Change4Life social marketing campaign, which is one of Public Health England’s flagship programmes, is encouraging individuals to make simple changes, and it is trying to work with people in the way that the shadow Minister mentioned. The campaign is trying to talk to people in language that makes it straightforward and easy for them to understand the good choices they can make for the health of both themselves and their family.

The national child measurement programme’s findings on childhood obesity are encouraging. We know that far too many people are overweight and obese, but we are seeing signs of encouragement. In 2012, childhood obesity rates fell for the first time since 1998, so we must not despair over the actions we have all taken and advocated over many years. We are beginning to see that such action can have an effect, but we must never underestimate how far we have to go.

In 2013, the global burden of disease study showed that the UK has the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis. The last data on diabetes care showed a 60% completion rate for all eight care processes recommended by the National Institute for Health and Care Excellence, which is a five percentage point improvement on 2010. We see progress, but we know there is much more to do. The Melbourne declaration is a timely reminder of the serious threat posed by the disease across the world, as well as here in the UK. I assure the House and my hon. Friend the Member for Torbay, who led this debate and leads the all-party group in such an exemplary way, that diabetes is a priority on which we continue to work hard. We are pleased to see progress, but we do not underestimate how much more there is to do. Such debates are welcome opportunities to keep the issue firmly on Parliament’s radar.

[Dr William McCrea (in the Chair)]

Mr Sanders, we still have a few moments. Do you want to make a few closing remarks?

Pharmacies and the NHS

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 20th November 2013 Westminster Hall

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

[Dr William McCrea (in the Chair)]

I thank Members for the courteous manner in which they conducted the debate.

Psychological Therapies

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 16th October 2013 Westminster Hall

[James Morris]

I thank my hon. Friend for that intervention. She has done a tremendous amount of work in that area. I totally agree with her point; we need to shift our emphasis towards much more early intervention and ensure that the issue she identifies is addressed.

[Dr William McCrea (South Antrim) (DUP)]

The burden of the hon. Gentleman’s address today concerns the therapies necessary to deal with mental health difficulties, but surely, as my hon. Friend the Member for Upper Bann (David Simpson) identified a few moments ago, the problem for the under-10s age group is that more research is needed into how a person under 10 is taken down the dark path of mental illness. We must find out what the problem is, as well as identify some of the treatment.

[James Morris]

The hon. Gentleman makes a good point. The chief medical officer is producing recommendations about children and young people’s mental health care, which will specifically look at evidence on why the prevalence of such difficulties is increasing. She is becoming concerned about the growing problem.

A consequence of no guaranteed or set waiting time is that thousands of people are awaiting referral while suffering severe anguish. A constituent of mine who is suffering from a relatively severe mental health problem has received a referral, but is still waiting for treatment. That wait has been going on for a long time and he is in a state of severe anxiety and anguish. That is the direct human consequence of the situation. We need to move towards a waiting time target. I know people are wary of talking about targets, but such targets speak to a parity issue in the health service. If we have waiting time targets for severe physical illness, it is surely right that we move towards waiting time targets for access to appropriate psychological therapies. Appropriate access builds in choice, meets the needs of individual patients and moves us away from the monolithic approach I described earlier.

When responding to the debate, I ask the Minister to consider the following points. We urgently need further research into the efficacy of long-term psychological treatments. We need more holistic research combined with a more flexible NICE regime; as I said, Professor Haslam recently acknowledged that work is needed on the way that NICE approaches recommendations in that area. We need to give serious thought to a new commissioning model assisted by some of the reforms that have been brought into the NHS, such as commissioning groups, and building on the any qualified provider model, which brings choice and capacity into the NHS by allowing the highly professional cohort operating in the private sector to provide therapy on the NHS through IAPT.

Would the Minister seriously consider making or at least working towards a commitment to a 28-week waiting time target for access to psychological therapies? Too many people are in a state of anxiety about when they will get treatment and what that treatment will be. We need urgent action, as other hon. Members have said, to ensure that the IAPT programme is further developed for younger people and children and we need to commit to further research into what is causing the disturbing trend in mental illness among our young people. We also need urgent action to ensure that older people are not locked out of the IAPT programme. The debate is about more than the right policies; it is important because we must address the anguish and suffering of our fellow citizens whose voices desperately need to be heard and whose stories are often the key to their cure.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to come here and support the hon. Member for Halesowen and Rowley Regis (James Morris), who has brought this matter to Westminster Hall for consideration. As my hon. Friend the Member for East Londonderry (Mr Campbell) said here yesterday, whenever we come to Westminster Hall, we congratulate the Member whose debate it is on bringing an important matter to the attention of the House. This is an important matter.

The hon. Gentleman clearly outlined the issues and their importance. My interest and that of my hon. Friends is in how such issues affect our young people. That will be the thrust of my speech. I also want to give a Northern Ireland perspective, which I believe is mirrored across the whole United Kingdom.

[Dr McCrea]

Does my hon. Friend agree that, for many years, mental ill health has been a taboo subject? Many of those suffering from mental health difficulties were pushed away or hidden from society. The value of such a debate is that it ensures openness in society, to deal with the important issue of mental ill health.

[Jim Shannon]

I thank my hon. Friend for raising that matter. That is exactly the problem; if I wanted to sum it up in one phrase, that is the phrase I would use. There was a taboo around mental ill health in the past, but hopefully we can discuss it now. I hate the word “mental”, because it almost puts the thought in one’s mind of someone to be kept at bay. We must be able to find another word in the English language that is more sympathetic. I am not sure what it would be, but we should give the matter consideration.

Psychological therapies are defined as an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behaviour—all issues the hon. Member for Halesowen and Rowley Regis mentioned—that have proved troublesome to the person seeking help from a trained professional. That is what we want to achieve.

The psychological therapies in the NHS 2013 event marked the halfway point of the coalition Government’s mental health strategy. Psychological therapies generally fall into three categories: behavioural therapies, which focus on cognitions and behaviours; psychoanalytical and psychodynamic therapies, which focus on the unconscious relationship patterns that evolved from childhood, which are important; and humanistic therapies, which focus on self-development in the here and now. We need to focus on those three categories.

I presume that most Members catch up on the news on BBC or Sky before they come here. A story today covered the role of carers and what they do for elderly people, but it also mentioned their role for those with mental health issues and focused in particular on the time that carers have to deliver care to people in those two categories. It underlined where we are in the debate about those who suffer from psychological imbalance and emotional issues.

The improving access to psychological therapies programme was built on evidence, produced in 2004 by the then National Institute for Health and Clinical Excellence, on treating people with depression and anxiety disorders. It was created to offer patients a realistic and routine first-line treatment, combined, where appropriate, with medication, which traditionally had been the only treatment available.

Things have changed. The Minister, whom I respect greatly, will outline the issues when he responds. The IAPT programme was dedicated to spending more than £700 million on psychological therapies between 2008 and 2014. It was first targeted at people of working age, but in 2010 was opened to adults of all ages. There has been success—it would be wrong to say that there has not.

In the first three years, 900,000 people were treated for depression and anxiety; 450,000 patients are in recovery, with another 200,000 moving towards recovery; 25,000 fewer people with mental health problems are on benefits; and the average waiting time has reduced from 18 months to a few weeks. In terms of what has been done so far, that is good news, but it is fair to say that there is a lot more to do. There has been a significant increase in the number of people with such issues, and all statistics indicate that that number will continue to grow.

People require psychological therapy for many reasons. Members have spoken about the things that lead to the position we are in today and why society and Government must respond. Reasons for therapy can be to do with home life and bereavement. On many occasions in my constituency office, we deal with bereavement and how it affects not only the partner, but the young people in the house. The hon. Member for Halesowen and Rowley Regis referred to that in his introduction. I regularly see it in my office—the frailty of life, the suddenness of death and how that affects people.

Unemployment, when young people who cannot get the jobs they need or the discipline that a job brings, and trouble in the workplace are other reasons for therapy. Another reason is childhood trauma, as we can see from the sexual abuse cases of the past few years. Many people were not aware of such trauma, but it existed. Social deprivation is another one, and all those issues contribute to where we are.

Spinal Cord Injuries

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 4th September 2013 Westminster Hall

[Ian Lucas (Wrexham) (Lab)]

It is a real pleasure to serve under your chairmanship this afternoon, Dr McCrea. I am pleased to see that the Minister is here for this debate on the important topic of continuing health care for spinal cord injured people. The all-party group on spinal cord injury has had some difficulty engaging with Ministers over the past two years. The Health Minister with responsibility for quality, Lord Howe, and more recently the Minister for Housing, the hon. Member for Hertford and Stortford (Mr Prisk), have both refused to meet the group, which is very unfortunate.

The advantage of engagement is that it enables Ministers to understand better the needs and difficulties of individuals who have to deal with severe spinal cord injuries. Such individuals face great hardship and difficulty, and Ministers should at least be prepared to engage with them and hear what they have to say. I am sure that the Minister will do so today.

I first became aware of the difficulties faced by spinal cord injured people during my work as a practising personal injury solicitor before I came to the House about 12 years ago. I was particularly engaged with the Midlands Centre for Spinal Injury at the Robert Jones and Agnes Hunt orthopaedic hospital in Oswestry. Individuals were often admitted with severe spinal injuries from accidents, and the capacity of the—[Interruption.]

[Dr William McCrea (in the Chair)]

Order. I apologise to the hon. Gentleman, but I must suspend proceedings for a Division in the House.

Health Inequalities

Lord McCrea of Magherafelt and Cookstown Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Stephen Barclay]

Will the hon. Gentleman—

[Dr William McCrea (in the Chair)]

Order.

Social Care Funding

Lord McCrea of Magherafelt and Cookstown Excerpts

Monday 11th February 2013 Commons Chamber

[Dr William McCrea (South Antrim) (DUP)]

No one can deny that elderly and vulnerable people across the United Kingdom live in fear of having to go into care and what that would mean to them. This is not only about England; it is about the rest of the United Kingdom. So what discussions has the Secretary of State held with the devolved Administrations to ensure that our elderly citizens have certainty, fairness and peace of mind about the costs of old age, such as he claims his plan will bring?

[Mr Hunt]

This is a devolved matter, as the hon. Gentleman knows, but different approaches are being tried in all four constituent parts of the United Kingdom and we must look at what is happening in the different parts and all learn from each other.

Suicide Prevention

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 6th February 2013 Commons Chamber

[Dr William McCrea (South Antrim) (DUP)]

I beg to move,

That this House recognises that the number of suicides in the UK, particularly amongst young people, represents a major challenge for government and society; acknowledges the work that is taking place to address the issue; calls for even more urgency to be shown in seeking to reduce the rate of suicides; notes the danger posed in particular by websites which promote or give information about harmful behaviours such as suicide; and calls upon the Government to adequately resource and promote child and adolescent digital safety.

For years this subject has been swept under the carpet. I believe it deserves a mature and thoughtful debate. Suicide is a significant problem in our society. Its impact is often sudden and shocking. While we can to some degree prepare ourselves for the death, through ageing, of elderly parents or the loss of loved ones through chronic illness, suicide catches us by surprise. Often there is no warning and we are left with a feeling of utter bewilderment. We ask: was it preventable? Were there warning signs that we failed to recognise? Was it simply a cry for help that went wrong? All of those are questions to which we will, regrettably, never receive an answer.

It can be seen that suicide touches the lives of many people and is, in every case, a tragedy both for the life that has ended and for the family, friends and community left behind. We must always remember that each person who has been lost to suicide has been someone’s child, someone’s parent, brother, sister or friend. Their passing leaves a wound that does not easily heal, even with the passing of time. In addition, those bereaved by suicide have special needs and require special support, for bereavement by suicide is itself a risk factor for suicide.

We cannot afford to ignore or be complacent about the prevalence of suicide and self-harm in the United Kingdom. Preventing suicide presents a serious socio-economic issue, as well as a political challenge. It is a problem that we all have a duty to address. There is a great need to change public attitudes and to increase awareness and understanding about suicide as a major public health problem that is largely preventable. Globally, almost 1 million people die from suicide every year. In the past 45 years, suicide rates have increased by 60% worldwide. Suicide is one of the three leading causes of death among those aged 15 to 44 years in many countries. Although suicide rates have traditionally been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries worldwide.

In 2011, 289 deaths by suicide were recorded in Northern Ireland, with the male suicide rate approximately three times greater than that of females.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate the hon. Gentleman and his party on securing this important debate on the Floor of the House. He references male suicide. Does he not agree that one of the more worrying statistics is that people who have just come out of prison are at a very high risk of committing suicide in the first two weeks of their release? Does he not agree that we should make better use of community and health care pathways to ensure that we can prevent and protect people who are very vulnerable, such as those coming out of prison?

[Dr McCrea]

I agree wholeheartedly about the importance of those pathways. It is vital that every effort be made to ensure that persons at a vulnerable moment in their lives—this is what the hon. Lady was talking about—receive the best possible support. I will develop that point later.

[Sammy Wilson (East Antrim) (DUP)]

Does my hon. Friend agree that, as well as prison leavers being vulnerable to suicidal tendencies, one of the groups at most risk are young males involved in the drug culture, and is it not odd, therefore, that some people are still campaigning to legalise drug use?

[Dr McCrea]

That is very true, and I agree wholeheartedly with my hon. Friend’s comments. Again, I will seek to develop that point later.

The figures I gave a moment ago represent a welcome reduction on the highest-ever recorded figure of 313 suicides in Northern Ireland in 2010. Nevertheless, Northern Ireland continues to experience higher rates of suicide among adolescents and young adults, particularly young men, than any other part of the UK.

Deliberate self-harm is also a significant problem, with a growing number of cases being seen in hospital accident and emergency departments. Statistics from the Department of Health, Social Services and Public Safety suggest that almost 500 patients presented at the hospital emergency department in Belfast with deliberate self-harm between April and June 2012. Many more incidents never come to the attention of health services at all. In 2011, the highest rate of registered suicides was recorded in the parliamentary constituencies of Belfast West and Belfast North. In my constituency, 18 lives were lost to suicide, 16 of them males.

[Mr Jeffrey M. Donaldson (Lagan Valley) (DUP)]

Is my hon. Friend aware of an international study highlighting the fact that Northern Ireland has the highest incidence of post-conflict trauma of any post-conflict region across the globe, and that this contributes to the high level of suicide? That is evidenced by the fact that much of it is concentrated in the parts of Northern Ireland where the conflict was fiercest, and it is added to by the fact that many of the people suffering trauma served in the armed forces. What we need in Northern Ireland, under the military covenant, is a specialist centre for the treatment of trauma for those who have served our country.

[Dr McCrea]

I thank my right hon. Friend for his intervention. I trust that the Minister will take those points very seriously.

Between January and September last year, 223 deaths by suicide were recorded in Northern Ireland, again with socially deprived areas in Belfast North and Belfast West worst affected. However, although we must concentrate particularly on Belfast North and Belfast West, where the rate is highest, suicide has, worryingly, been spreading not only in urban communities, but into rural Northern Ireland—into those areas where people feel isolated and vulnerable to thoughts of suicide.

[Bob Stewart (Beckenham) (Con)]

Does the hon. Gentleman have any idea whether there is a link between suicide and past membership of illegal organisations, and whether those who were inclined to carry out such violence have become so depressed that they take their own lives?

[Dr McCrea]

Once again, I hope to touch on that point. I believe that that link needs to be considered. Certainly, for many people who were involved in such activities—perhaps they were drawn into them and now, unfortunately, must live with the consequences for the rest of their lives—guilt can be a leading factor pushing them towards suicide.

The Bamford review on mental health promotion, published in Northern Ireland in May 2006, reinforced the need to prevent suicide. It found that in the 25 years from 1969 to 1994, more people died by suicide than as a result of the troubles in our Province.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate the hon. Gentleman and his party on bringing this important debate to the Floor of the House. He talks about the factors linked to suicide. Will he accept that mental health issues are another key factor linked to suicide and that MPs and others need to remove the stigma attached to mental illness so that people feel able to ask for the help they badly need?

[Dr McCrea]

I agree wholeheartedly with those remarks. The Bamford report highlighted the link with mental health. I agree that we must remove the stigma attached to mental health, as well as the stigma attached to suicide, because many families are deeply hurt by it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is the hon. Gentleman aware of research carried out by Louis Appleby, the suicide tsar, showing that 75% of those who commit suicide have had no connection with mental health services, and that it is dangerous to focus suicide help and support only on mental health teams? If we do that, we risk failing to protect many of those who need our help.

[Dr McCrea]

I thank the hon. Lady for her interest in this matter and for commendably seeking to highlight it in one of the Committee Rooms. There is no one reason for a person coming to that place where they feel that suicide is the only way out.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I hope the hon. Gentleman realises how much appreciated his colleagues’ choice of subject is today. I declare two interests: I am joint president of a Samaritan branch, through past family links, and I am involved with the organisational charity, Papyrus, which campaigns to prevent suicide among young people in the UK. May I accentuate what he has said? People can feel as depressed in rural areas as they do in urban areas, and there can be no presumption about the reason. Teenagers can be very depressed because of medication—I have had family experience of that—and university students because of the pressure of their studies and relationships. It can be for anybody at any time, and organisations such as the Samaritans and Papyrus ought to be known abroad, so that anybody can reach them on the phone.

[Dr McCrea]

I agree wholeheartedly with the right hon. Gentleman’s comments. I have found a lack of knowledge in the community about the help available through such agencies.

We community leaders must be willing to say, “This is not a taboo subject. We can talk about this.” The country must be willing to open up. We tell young people to open up when they have a problem or feel isolated, but we legislators must be willing to do the same, and not run away from the issue, treating it as something to be hidden or pushed aside.

I am delighted that my right hon. and hon. Friends have brought this debate before the House today—I know that I have support on this issue from across the political spectrum in Northern Ireland—but I really feel that this is a problem right across the United Kingdom. As I pointed out at the beginning, in one year, 1 million people across the world reached the point where they took their own lives. That is very serious and we are not immune to it—not one part or region of the United Kingdom is immune and I can assure hon. Members that not one family is immune either. This issue can touch every family, no matter how rich or how poor. Every family can experience the very same pain and hurt that has been expressed to me. That is why we have secured this debate.

The report also found that, on average, deaths due to suicide since 2000 have exceeded deaths on the roads and concluded that suicidal behaviour places a heavy human and financial burden on society in Northern Ireland, with an annual cost to the economy of £170 million owing to work days lost and hospital admissions for attempted suicides and suicidal behaviour. Research undertaken by Mike Tomlinson of Queen’s university in 2007 found that the Northern Ireland suicide rate had grown since the mid-1990s, which was attributed to younger people, particularly men, taking their own lives.

[Rehman Chishti]

The hon. Gentleman talks about young people. Does he know whether there have been any discussions between the devolved nations about preventing young people from accessing suicide websites? Such prevention work is crucial.

[Dr McCrea]

Once again, I am deeply appreciative of the hon. Gentleman’s intervention and I wholeheartedly agree with him. We will endeavour to take up that point as the debate continues.

Tomlinson found that about 150 suicides were recorded annually between 2000 and 2004, but by 2006 that figure rose to 291. He argued that the end of the conflict in Northern Ireland might have brought its own problems. Figures released by the Office for National Statistics show that in 2011 there were 6,045 suicides among people aged 15 and over in the United Kingdom—an increase of 437 compared with 2010. The UK suicide rate increased significantly between 2010 and 2011, from 11.1 to 11.8 deaths per 100,000 of the population. That trend was further reflected in Wales, which recorded 341 suicides—its highest rate since 2004. Scotland also saw an increase, from 781 deaths by suicide in 2010 to 889 in 2011.

[Jim Shannon (Strangford) (DUP)]

I thank my hon. Friend for setting the scene so clearly for everyone in the Chamber. The suicide rates over the last few years, which he has outlined, cover the period of the economic downturn. Does he feel that, at this time especially and for that very reason—the economy and the downturn in jobs—there should be a greater focus on suicide across the whole of the United Kingdom?

[Dr McCrea]

I thank my colleague for his intervention.

Although I have given a lot of statistics—I will come to some of the causes in a moment—they can be very cold things. I want to draw the House’s attention, very earnestly and gently, to the fact that behind every statistic is a personal tragedy—a personal tragedy that a person reached the point where they felt that there was no other way to go; a personal tragedy because no one can fully understand the loneliness or desperation that a person feels trapped by whenever they reach the point at which they think that the only way out is suicide.

There is no one reason why people take their own lives. It is often a result of problems building up to the point where that person can see no way out to cope with what they are experiencing. Factors that have been linked with suicide include unemployment; economic decline; personal debt; painful and disabling illness; heavy use of, or dependency on, alcohol or other drugs; children and adults dealing with the impact of family breakdown; the loss or break-up of a close relationship; depression; social isolation; bullying; and poor educational attainment. Those experiences have been shown to make people more susceptible to suicide. It may be that a seemingly minor event becomes the trigger for them attempting to take their own lives—on many occasions not to die, but simply to get relief from their unbearable pain. Low self-esteem, being close to tears and not being able to cope with small, everyday events are all signs that someone is struggling to cope with overwhelming feelings. Yet it is often difficult to tell whether someone is suicidal or depressed, as people in crises react in different ways. Uncharacteristic behaviour can often be a sign that something is very wrong.

One of the main problems that I want to address in this debate is: where do people turn to for support and help? Let me first acknowledge the work done by our front-line health and social care professionals, and the effort that has gone into the development and delivery of suicide prevention strategies, which aim to identify regional risk factors, establish key objectives via a cross-section of organisations, and seek ultimately to reduce rates of suicide and self-harm throughout the United Kingdom. For example, in Northern Ireland, I appreciate our ministerial co-ordination group in the Northern Ireland Assembly. It was established in 2006 to ensure that suicide prevention is a priority across relevant Departments and to enhance cross-departmental co-operation on the issue. I was delighted by the changes made by Minister Poots, so that instead of the group meeting on a needs basis, it meets regularly to provide the sustained effort and leadership needed to reduce the high rate of suicide in Northern Ireland. I commend him for taking a long-term, upstream intervention approach to the problem.

However, in addition to Government-led initiatives in England, Wales, Scotland and Northern Ireland, credit must be given to the agencies and voluntary organisations working at the heart of our communities to provide a vital lifeline when one is needed most. I acknowledge the excellent work done by many Church organisations, which give spiritual counselling to many who feel that life is so burdensome that it is not worth the struggle. These organisations—whether Government agencies, voluntary agencies or Church agencies—have a vital role to play in complementing local mental and public health services. This work at the coal face is truly inspirational. I pay tribute to the men and women who dedicate so much of their lives to helping others.

I said earlier that people needed to know about the availability of those who are willing to help. I say that because about three weeks ago a conference was held in my constituency in Antrim after two suicides had taken place—it was not called by politicians, but by the community, because of a desire in the community to do something. I was delighted and honoured to be part of that occasion, but what I found out that day was that although a multitude of organisations deal with the problem, many in the community do not know about them. Many do not know where help can be got at the moment it is needed.

Over the past year I have had the pleasure of working closely with my right hon. Friend the Member for Belfast North (Mr Dodds) with PIPS—the Public Initiative for Prevention of Suicide and Self-Harm—a not-for-profit organisation in Belfast North that has been delivering suicide prevention and awareness training since 2008. Through my association with PIPS, I have come to understand how it believes that, through training local people to be more aware of the risk of suicide and of the sources of help available, our communities will be safer and more people will be saved from taking their own lives. Surely this must be all about prevention, because, unfortunately, there is no cure when suicide takes place.

[Bob Stewart]

I am listening intently to the hon. Gentleman. Does he think that there is anything the Northern Ireland Assembly or the Government could do to provide publicly funded advertisements on this matter on television in Northern Ireland, for example? Does he also believe that priests could raise the matter when they are preaching, to alert their congregations to the problem? Perhaps he will come to those points in his speech.

[Dr McCrea]

Again, I thank the hon. Gentleman for his intervention; I will come to those points. I certainly have endeavoured, when speaking in congregations, to remind them of the loneliness that people experience when they are in that vulnerable situation. No one knows the depths of that valley; no one knows how dark is the night that they are walking through. There must be greater understanding, and we can gain that understanding if people talk to each other and express their own experiences, as is happening in Antrim. That is helpful not only for them but for our understanding and for that of the community.

Members will also be aware that I have spoken recently in the House about child and adolescent internet safety, following horrific reports in the media of young people taking their own lives as a result of cyber-bullying.

[Mr Donaldson]

My hon. Friend referred to support groups. I have recently met members of Horizons, a local support group in Lisburn. It is doing excellent work on a voluntary basis, but it is struggling to get the funding that it needs. Many of its members have had family experience of losing a loved one in these circumstances, and they are well placed to provide the support that our communities need, because they have walked through that dark valley. Greater priority for the funding of such groups is essential.

[Dr McCrea]

I thank my right hon. Friend for that intervention. In fact, the motion

“calls upon the Government to adequately resource and promote child and adolescent digital safety.”

The motion goes wider than that, but resources are certainly a problem that such organisations need help with.

The internet and new media are prominent features in youth culture nowadays. Young people see the use of technology as a vital part of their social lives, and the online environment has created unique opportunities for learning, connection and communication. Almost 99% of children aged between eight and 17 access the internet, and 90% of children aged five to 16 have a computer at home. Although the risks created by the internet and new media have yet to be properly assessed, there is growing concern over the use of the internet for cyber-bullying and for normalising and encouraging suicide and suicidal behaviour.

The Byron review, conducted in 2008, entitled “Safer Children in a Digital World”, found that

“there is a range of material on the Internet that may present particular issues for specific groups of children and young people. This includes content or sites that promote or give information about harmful behaviour such as suicide and self harm”.

The report found that, although some children might be deterred from harmful behaviours by witnessing such content, or might find emotional and social support from others experiencing the same feelings, it was clear that for some children there were major risks. Sites providing information about suicide techniques, for example, could increase the chance of a suicide attempt being successful and decrease the chances of a young person receiving help.

[Mrs Moon]

The hon. Gentleman will be aware that the hosting of such sites is illegal in the United Kingdom, thanks to the Coroners and Justice Act 2009. The problem is that many of those sites are hosted outside the UK, where they are not illegal. Internet providers need to block access to the sites. They move them down the access chain when people google them, but they do not block access to them altogether. How can we ensure that access to those sites is blocked?

[Dr McCrea]

I thank the hon. Lady for that intervention. I intend to touch on that point in a moment.

[Simon Hughes]

The hon. Gentleman is covering lots of bases. One of the issues that we face as a society is that young people can become isolated from contact with other young people, other than through the internet or texting. That is a real danger zone. They retire to their bedrooms and they are not seen from one night to the next. Their communication with others is limited. The exercise of parental and family responsibility, to ensure that youngsters are out and being monitored so that people can pick up signs that they might be led to suicide sites, is as important as dealing with the sites themselves.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I point out to Members, in relation to those last two interventions, that such interventions should come through the Chair? Instead, they have been focused on the hon. Member for South Antrim (Dr McCrea), whom we all wish to hear.

[Dr McCrea]

I agree with the point that the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) makes. I was talking to folks at the weekend about how young people isolate and withdraw themselves. If we set our minds back to just a few years ago, we remember that we used to see children playing football on the streets, and little girls out with their prams. If we look at our streets today, we see very few children out there. So where are they? They are in their rooms. They are not with their families. In many cases, the internet has taken over their lives, and that leads to the isolation that the right hon. Gentleman mentioned.

When online discussions or communities emerge around harmful behaviours, there is a risk of what the Samaritans describe as an “echo chamber”, in which users reinforce each others’ behaviour and negative feelings about themselves. In a communication to me, the Samaritans stated that

“there are some aspects of the ways that individuals interact with one another online, through social networking sites or online chat rooms, that can place vulnerable people at risk by exposing them to detail about suicide methods or conversations that encourage suicide ideation. Indeed in recent years there have been several widely reported cases of individuals taking their own lives having used websites that have provided explicit information on suicide methods or have been used to facilitate suicide pacts. Restriction of access to information about suicide methods is an established component of suicide prevention. However, this is particularly difficult to achieve online not least because suicide related websites hosted abroad are legal in most other countries”.

The Samaritans have worked in partnership with major companies to develop practical initiatives to support people at risk from suicide online. In November 2010, an initiative was launched in partnership with Google to display the Samaritans helpline number and a highly visited telephone icon above the normal Google search results when people in the UK use a number of search terms related to suicide. The Samaritans also worked closely with Facebook to allow users to get help for a friend they believe is struggling to cope or feeling suicidal. We must express our appreciation to the Samaritans for doing this excellent work.

These pioneering initiatives are to be commended, but more must be done. The Department of Health suicide prevention strategy in England recognises the need to continue to support the internet industry to remove content that encourages suicide and to provide ready access to suicide prevention services. In Northern Ireland, the refreshed “Protect Life” strategy includes a new objective to develop and implement internet guidelines that seek both to restrict the promotion of suicide and self-harm and to encourage the circulation of positive mental health messages.

Online risks must be managed more effectively, and advertisements with hyperlinks to support services must be displayed whenever users discuss or search for information about harmful behaviour if we are to ensure that people in distress can access useful resources quickly.

I acknowledge that the Byron review calls for a shared culture of resilience with families, industry, Government and others in the public and third sector all playing their part to reduce the availability of potential harmful material, to restrict access to it by children and to increase children’s resilience. There needs to be a greater understanding of how young people use modern technologies and communications if they are to be engaged in respect of suicide awareness and prevention, and mental health and well-being.

In conclusion, the causes of suicide are multiple and complex, and they cannot be addressed by any one Government Department working in isolation. Recent years have seen a commitment by Government to deliver suicide prevention strategies throughout the UK, but these must be adequately resourced on a sustainable basis if the progress already made is to be maintained. While we must acknowledge the good work already taking place, there is, of course, always room for improvement, and I believe that efforts must be concentrated on making the internet a safer place for our young people.

I recognise that this is a particularly complex matter and that the challenges it presents are indeed multiple. None the less, they are challenges that must be overcome, for children have the right to be protected from all forms of abuse, violence and harm. Enhanced internet safety is only part of the solution to the growing problem of suicide and self-harm. Through a co-ordinated approach, we must effectively address the issues impacting on emotional health so that we reach a point where so-called “suicide” sites will no longer be attractive to vulnerable individuals and will be made naturally obsolete or unattractive to view. We need to think innovatively about what more can be done across government and the community to reduce the rate of suicide in the UK.

I trust that my right hon. and hon. Friends will deal not only with the issues I have touched on, but with the families of those who have experienced suicide, because they also need help.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I congratulate the hon. Gentleman on the speech he is making in leading this debate and on the tremendous work he is doing to highlight the issue in this place. He has mentioned the refreshed “Protect Life” strategy, and it is good to know that that strategy is developing under devolution. He may just about remember that I was the Minister with responsibility for health at the time when that was launched in 2006. On the hon. Gentleman’s point, I emphasise and ask him to emphasise how important it is for the families of those with direct experience to be at the core of that strategy because they better understand the issues at stake and can inform us all about the best way forward.

[Dr McCrea]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I wish to be helpful to the Chamber, and point out that Members are meant to speak through the Chair rather than to the individual Members concerned. I know that some Members have not been on the Back Benches for a while, but I hope that they are back into the swing of being in opposition and will remember to speak through the Chair.

[Dr McCrea]

I concur with the remarks of the right hon. Member for Wythenshawe and Sale East (Paul Goggins). I can honestly say that there was no better person than himself to introduce and bring in this sort of measure from the beginning. He certainly did sterling work on it, and we in Northern Ireland appreciate what he did, and want to carry it forward to the next step. Thus families in their grief, bewilderment and loss need help and should be at the very heart of whatever next step is taken. The emphasis on suicide prevention must remain, for as the Stamp Out Suicide! website plainly notes:

“once a suicide is completed, very sadly, there is no cure.”

Hospital Services (South London)

Lord McCrea of Magherafelt and Cookstown Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Ms Harriet Harman (Camberwell and Peckham) (Lab)]

I thank my hon. Friend for giving way and I join the hon. Member for Dartford (Gareth Johnson) in congratulating her on securing this debate.

On the impact on neighbouring hospitals, my hon. Friend will be aware of the importance—not only to local people but to London as a whole—of King’s College hospital. Is she also aware that the effective closing of maternity and A and E services at Lewisham hospital will hit like a tidal wave at King’s College hospital, because of the numbers of people involved. The health service estimate is that the number of people at King’s College A and E will increase by 45%. The staff at King’s College A and E do a very good job, but they will not be able to cope with a 45% increase in patients. The additional emergency admissions from that increased number of people at A and E will create such a strain on in-patient beds that the proposal is that in-patients—non-emergency admissions—will have to be shipped off to Farnborough hospital, which is an hour away on a bus and a train from Camberwell.

As for maternity services, the situation is even more pronounced, with a 54% increase envisaged in the number of women giving birth at King’s College hospital. The staff there simply cannot cope with that increase. At the moment, many women are turned away and told to go—guess where?—to Lewisham hospital.

[Dr William McCrea (in the Chair)]

The right hon. and learned Member for Camberwell and Peckham (Ms Harman) will know that interventions must be short. Certainly, however, the point she makes is well made.

[Heidi Alexander]

My right hon. and learned friend encapsulates the issues in relation to King’s College hospital perfectly.

The fact of the matter is that millions of pounds will have to be spent at neighbouring hospitals to enable them to do the job that doctors and nurses at Lewisham hospital are already doing very well. Roughly £200 million has to be spent on making those changes happen, and that is not to mention the £12 million that has just been spent on Lewisham hospital’s A and E department.

In my view, this process is sheer madness. I do not think that there is any guarantee that money will be spent in the right places. If the predictions about where people will go after the closure of the A and E department and maternity department at Lewisham hospital are not right, we will end up spending money on the wrong hospitals. That could result in complete chaos. I cannot see the sense in the proposal, and neither can thousands upon thousands of people in south-east London.

The proposed closure of Lewisham’s A and E department and maternity department would also mean that two thirds of the building and land at Lewisham hospital would be sold off. These plans were hidden in an appendix to the initial proposals document, which was first published at the end of October last year.

I cannot overstate the opposition to these plans. More than 40,000 people have signed a petition against the closures; not one Lewisham GP is in favour of the changes; and the chair of the local commissioning group is also opposed to them. Put simply, these changes are unwanted.

--- Later in debate ---

[Simon Hughes]

I have no reason to disbelieve what the right hon. Lady says, but even more important is returning the decision to the people in the health service who are now meant to be leading it—the GP commissioners and others. That is what all of us, in different ways, believe needs to be done. She made an argument for the issue being London-wide, and that of course is the context, but the practicalities of travel and transport, whether buses, cabs, cars and trains, are such that south-east London works as a segment for health service use in a way that does not really cross over into other parts of London, other than to King’s. The only knock-on bits are the small amount of crossover to the London hospitals for specialist reasons, and some to King’s because it is so near—technically, it is south-east London, but it is in Lambeth.

Secondly, the precedent would be a bad one to set for those parts of the NHS that have been financially well managed, compared with parts that have been badly managed. Lewisham has been relatively well managed, being very nearly in balance. We rely on trusts to do their job locally and on people to manage local trusts, so we have to support those who do that job well and responsibly.

My last point is probably the most important. I have been to Lewisham A and E and visited patients there privately. It and the maternity services have developed a reputation for good clinical care of all who attend it. That was not the case some years ago, but it has been worked on, and not only physically. It has become a university teaching hospital, as well as being a local general hospital, and it has good community links—the point made by the right hon. Member for Lewisham, Deptford in her intervention. It has also built up a good reputation for integrating acute care, hospital-centred care, with community provision.

The Secretary of State could take the clinically easy decision to follow the trust administrator’s recommendation, saying, “This is what has been recommended, therefore I am following what I have been told”, but I hope that he realises the greater benefits to the local community and to the wider health economy and service of south-east London, as well as to the Government if they are seen to be listening to the people and to the GPs more than to the trust special administrator. I understand why the trust special administrator takes a hard line, because he is a health economist and his interest is finance. The Health Secretary, however, has a different job, which is to be responsible for the NHS in England, and that means making responsible decisions to secure a good NHS in all parts of south London and elsewhere.

[Dr William McCrea (in the Chair)]

I will be commencing the winding-up speeches at 10.40 am at the latest. Three Members are seeking to catch my eye, so I ask them please to be conscious of that in their contributions, because I would like to get as many Members in as possible.

Oral Answers to Questions

Lord McCrea of Magherafelt and Cookstown Excerpts

Tuesday 12th June 2012 Commons Chamber

[Paul Burstow]

The important point about the extension of any screening programme is that it is based on evidence. The most recent review of cervical smear and screening campaigns took place in 2009, and on the basis of all the available evidence at the time the Government’s advisory committee on cervical screening concluded that it would do more harm than good to extend screening below that age, but it is a standing item on the committee’s agenda. It looks at any new evidence and will continue to do so.

[Dr William McCrea (South Antrim) (DUP)]

Pancreatic cancer is greatly feared by many of our constituents. What funds are going to be made available to assist in its research, and how will the Minister measure improvements in that field?

Mental Health Care (Hampshire)

Lord McCrea of Magherafelt and Cookstown Excerpts

Wednesday 18th April 2012 Westminster Hall

[Andrew Griffiths (Burton) (Con)]

I will speak briefly in support of my hon. Friend the Member for New Forest East (Dr Lewis). We have joined together on many occasions to campaign on the provision of acute mental health facilities, and today I shall express my concerns about how these processes are being undertaken by primary care trusts across the country. If anybody wants to see why the health care reforms that the Minister has fought so valiantly to introduce are needed, PCTs’ actions and decisions to close mental health facilities are the perfect example and demonstrate how they are out of touch, need reform and need to change.

Sadly, three weeks ago South Staffordshire PCT took the decision to close Margaret Stanhope Centre, a unit of 18 acute mental health beds in my constituency. It took that decision not only in the face of huge opposition from local people—8,200 people signed a petition as part of a campaign run by my local newspaper the Burton Mail and the Friends of Margaret Stanhope campaign group—but in the face of the evidence. I am a new Member of Parliament, elected for the first time at the last general election, and I had always assumed that such decisions were based on fact and on evidence—that the PCTs that took such important and often life-threatening decisions would be able to stand up to defend their decisions by proving their case. However, in the closure of the Margaret Stanhope Centre the PCT acted irresponsibly, recklessly and had no factual evidence to back up its decisions.

We conducted some research and found an Audit Commission report: 46 PCTs across the country had taken part in a benchmarking exercise, and the report showed that the average provision of acute mental health beds in those 46 PCTs was 27.5 beds per 100,000. In my trust, however, provision was 14.5 beds—almost half that average. The PCT then prayed in aid the following report, produced during the consultation process. It claimed that, miraculously, its provision had shot up to 31 per 100,000, and that there was nothing to fear.

I tried to get the facts. I tried to get the information. I asked and I asked and I asked for independent data. When the data came, they showed that the PCT had got its figure wrong: provision was not 31 beds per 100,000, but 22. However, when analysing the raw data, the PCT had included such things as mother and baby post-natal depression beds, beds for eating disorders, and drug and alcohol rehabilitation, so actually the figure for provision came out at 13.2. The PCT then prayed in aid an independent report that it had commissioned from Staffordshire university. We asked for that report. When we received it—it took two and a half months to come—we found that the person who had conducted the independent report, Dr Eleanor Bradley, was being paid not only by Staffordshire university, but by the NHS trust. The independent report that it claimed demonstrated how safe it was to close the Margaret Stanhope Centre was actually conducted by somebody on its payroll.

One claim made in the report was that the PCT had been able, through a pilot scheme, to reduce the in-patient stay by a third, but when we managed to drag the report out from the PCT, we discovered a number of things. First, we discovered that for stays in Margaret Stanhope of more than 91 days, it had managed to reduce average stays beyond 91 days by more than a third, from 39 days to 23—a reduction of 41%. However, the vast majority of admissions—88%—were between two and 90 days, and there the reduction was just 1.1%. The PCT claimed to have reduced in-patient stay by a third, but had actually reduced it by just 1.1%. I could go on about how flawed was the evidence used by my PCT to justify the closing of a much loved and much valued unit that serves the most vulnerable in my community. The process began some four years ago, so this is not a party political point, but a point about the actions of the PCT.

We met three weeks ago to discuss the passionate campaign for the continued existence of the unit. The process used to make that decision—

[Dr William McCrea (in the Chair)]

Order. May I draw the hon. Member’s attention to the fact that we are having a debate on the closure of acute adult mental health beds in Hampshire? I am sure that he is building his case from his experience, but it must be linked directly with the situation in Hampshire.

[Andrew Griffiths]

Forgive me, Dr McCrea. I will do exactly that and draw my speech to a close.

What I have seen is that the processes are flawed. What I have seen is that PCTs cannot be trusted to make the decision in Staffordshire and they cannot be trusted to make the decision in Hampshire. It is essential that we reassure the most vulnerable in our communities and in society. It is essential that the Minister understands their concerns properly and reassures himself that the decisions being made in Hampshire, and the decisions made in Staffordshire, are correct and are based on fact and evidence. I urge the Minister to train his laser-like vision on this important issue and to reassure himself, so that he, we and our constituents can be confident that mental health provision in Hampshire and in the rest of the country is not being jeopardised by false decisions made by people who are unaccountable, unelected and are not making those decisions in the best interests of our constituents.