Young-onset Parkinson’s Disease

Madeleine Moon Excerpts

Monday 6th March 2017 Commons Chamber

[Nick Thomas-Symonds]

I entirely agree with the hon. Gentleman.

I have been provided with a number of emails by the charity Spotlight YOPD, and I have permission to use them in this debate. Interestingly, one of those contributions is from someone with Parkinson’s who is based in Edinburgh. They say:

“My main concern is the lack of clinical trials to participate in, compared to many other conditions, there’s hardly anything at all going on for PD.”

I will talk in a moment about the care that people receive, but I agree with the hon. Gentleman that research into a cure is absolutely central to this debate.

I want to talk about a constituent of mine, Hayley Huxley, to whom I have been speaking in recent weeks. She was diagnosed with Parkinson’s at the age of 25. She is now 30 and has two young children. I want to reflect on what she set out in an email to me, because it is indicative of what people go through. She says:

“It all started when I was 24. I went back to work after maternity leave on my first child and noticed I couldn’t use my right hand properly to write. I went to the doctors 3 times and they just put it down to carrying a car seat, pulled muscle, etc. The 4th time I went I got referred to a specialist and went for tests”,

and she was diagnosed at 25.

Hayley speaks movingly of the challenges that she has faced, such as working part time due to fatigue and having to

“fight my way through the PIP assessments”.

In the end, she was able to get the appropriate number of points. She also speaks about access to a neurologist, saying that she has not seen one since she was diagnosed five years ago. Indeed, she has not seen her Parkinson’s nurse since July 2015. She speaks about managing her medication, going through childbirth without taking medication for eight months, the rigidity in her right arm and leg, and the restless leg that she gets.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is my hon. Friend aware of the Parkinson’s KinetiGraph watch? It is new on the market and was developed by Global Kinetics Corporation. It monitors the medication taken by a Parkinson’s patient and will send a message over the internet to a consultant with information about whether the medication is at the right level and has been taken at the right time, thereby enabling people to stay in work longer and to control their tremors much better.

[Nick Thomas-Symonds]

I am grateful to my hon. Friend for that point. The device sounds remarkable and could assist people with the condition.

Hayley spoke about the restless leg she experiences if her medication is not taken at the right time or if she is under stress. The way in which Hayley has dealt with the condition is inspirational. When I saw her yesterday in advance of this debate, she said that while those who fit into what is called the young-onset group have particular needs, there is a collective sense of need for everyone with the condition. The photographer who was with us yesterday, Ron McCann, also has Parkinson’s and is aged 69. Over the course of the weekend, I was contacted on social media by a member of the male voice choir in my hometown of Blaenavon, who spoke about a chorister in his 80s who is battling the condition and has found that singing has assisted him.

While there are issues that unite all with the condition, including access to the drug Duodopa, which was the subject of a recent debate in Parliament, those who are diagnosed at a younger age have specific needs. The first issue is with being diagnosed in the first place, because the condition can go undiagnosed. Those who have contacted Spotlight YOPD talk movingly about what happens at that moment of diagnosis. Keith from Newark says:

“Parkinson’s for younger people (under 50) is a different kettle of fish...It completely changes your life but you don’t know at the time and no one actually tells you.”

Gaynor from Rye says:

“I’ve never felt quite so lonely as when I was diagnosed. Mourning for the future I thought I had—suddenly old before my time with a fear of dependency—and no one there to gather me up; no one to depend on.”

Jordan, 21, an MSc student in Liverpool, says that

“the GP kept saying, ‘He’s too young, he’s too young,’ and said it was a psychological problem.”

Even when the diagnosis is established, there then comes a whole set of new challenges. On top of dealing with the condition, there are all the pressures of family and working life.

[Nick Thomas-Symonds]

I entirely agree with the hon. Gentleman that local support groups are hugely important, which leads me on to the mental health issues that often come with Parkinson’s. Although access to a neurologist is highly important, we must not neglect access to mental health support.

Prescription charges remain a bone of contention in England. Pre-payment certificates are available to reduce costs, but there is still a cost. England could do with following the lead set by the Welsh Government in 2007 by abolishing prescription charges altogether.

There are also issues of engagement with medical services. Again, I can refer to specific cases. Jon, a father of three who was diagnosed at the age of 49, says:

“People with Parkinson’s can often have problems in hospital.”

Why? People with Parkinson’s are often deprived of their medication because, obviously, they hand in their medication when they go into hospital, yet maintaining a regular medication regime is very important and the person themselves is often best placed to do that.

I spoke a moment or two ago about access to neurological services. Alison, a mother of three based in Cheltenham, says:

“I feel let down by an NHS system that offers me one 10 minute appointment with a neurologist each year and I have to chase this to get it.”

Neurological services clearly need to be more accessible than that.

I do not make my next point in an ideological way, and I am pleased that the former Minister with responsibility for disabled people, the hon. Member for North Swindon (Justin Tomlinson), is in the Chamber. Irrespective of political views, I want to address the efficiency of the social security system as it actually works. I pay tribute to the work of Parkinson’s UK, and particularly to that of Natasha Burgess. On employment and support allowance, for example, which will involve a work capability assessment, the problem with something like Parkinson’s is that it is a variable condition.

[Mrs Moon]

Unpredictable.

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[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Let me start by congratulating the hon. Member for Torfaen (Nick Thomas-Symonds) on his speech, which the former Minister, my hon. Friend the Member for North Swindon (Justin Tomlinson), called an important one. It is just that, as this is an important subject. It is salutary to think that it is 200 years since this terrible disease was first discovered and we are still some way off finding a cure for it. I know that over the past year or so the hon. Gentleman has asked many questions in Parliament, both written and oral, on this subject. I congratulate him on doing that, because it is only by people doing that that we will continue to keep awareness high.

I also thank the hon. Member for Bridgend (Mrs Moon) for the work she does on the all-party group and for demonstrating the kinetic watch. I had not seen one before this evening, but I look forward to seeing it perhaps after this sitting.

[Mrs Moon]

I met people from Global Kinetic on Friday, when they gave me the watch. In September or October, this watch will also have a docking station, which will mean that on a daily basis the consultant neurologist will be able to get a pattern of sleep, movement and medication consumption from a patient. We hope that will cut the need for neurologist appointments, as is happening in some areas, and I hope that the Minister will want to meet Global Kinetics.

[David Mowat]

Indeed. I am sure other brands are available—

[Mrs Moon]

No, they are not.

[David Mowat]

Well, as I was saying a few moments ago, there is no cure for this disease but it is possible to manage the symptoms and alleviate them. However, to do that we have to have a diagnosis, and that is the issue we are talking about today, particularly in the case of early-onset Parkinson’s disease.

On the prevalence of the disease, something like 130,000 people suffer from it—that is likely to be 160,000 by 2020—and 95% of them are over 60 years old. Because of that fact, there is a tendency in the medical profession and, indeed, in society at large, to think that it is a disease of older people. To an extent that is true according to the statistics, but we also know that something like 5,000 or 6,000 people under 50 have the disease. I will talk about the statistics a little more later, because the hon. Member for Torfaen did challenge them, and it is true that the numbers are all estimates. Nevertheless, the number I have is that something like 400 people under 40 have the disease. Incredibly, it is thought that a few dozen people get the disease under the age of 20, which is a terrible thing as it means that it is with them for their entire working lives.

Parkinson’s is a progressive disease caused by the death of cells containing dopamine. As we have heard, it causes tremors, slowness, speech impediment and gait disorder. Its severity varies, as recognised in some of the points made about the Department for Work and Pensions. There is no cure; the best we can do is to manage the symptoms by trying to address the lack of dopamine through techniques such as brain stimulation, and apomorphine is the most commonly used drug. The hon. Member for Torfaen mentioned the recent debate on Duodopa; I do not intend to go over that in detail, other than to say that it is very much a minority treatment, with something like 75 people receiving the medication. It is typically used when other treatments are not successful.

We all—the Government and the country more generally—need to build awareness of the prevalence of early-onset disease. The NHS Choices website has information on the local and national support groups we heard about a few moments ago. Parkinson’s UK does a huge amount of work in this area, and I would of course be happy to meet it and the hon. Member for Torfaen.

Children’s Wellbeing and Mental Health: Schools

Madeleine Moon Excerpts

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb]

I thank the hon. Lady for that intervention and pay tribute to the tremendous campaigning work that she does on mental health. Her point highlights the gap between the rhetoric, which is often well intentioned, and the reality. There is now a much greater focus on prevention in the Government’s argument, but what too often happens with a system under impossible strain is that the preventive services are cut first because there is a desperate need to prop up acute services within the system. She makes an important point.

Let me address the issue of stigma in schools. Stigma can exacerbate mental health conditions and prevent people from speaking out and seeking help. In October 2016 the YMCA launched a nationwide campaign aimed at tackling the stigma associated with mental health difficulties and to help to encourage young people to speak out. It found that more than one in three young people with mental health difficulties had felt the negative impact of stigma. School is where most young people experience stigma, and more than half of those who have experienced stigma said it came from their own friends. There is often a lack of understanding among young people—teenagers—about what mental health really is. That is why it is so important that we get this on the curriculum so that every teenager learns about their mental, as well as physical, health and wellbeing, and about how they can become more robust in coping with the challenges they face.

The impact of stigma is profound and pervasive, affecting many areas of a young person’s life. Young people reported that the stigma affected their confidence and made them less likely to talk about their experiences or to seek professional help. I can remember the moment when our eldest son said to me, “Why I am the only person who is going mad?” I just thought that here is a teenager feeling that and having stored it up inside himself, having not been able to talk about it for a long time. We can just imagine the strain of trying to cope with that on top of all the normal pressures of being a teenager. We have to do far more to combat stigma if we are to improve young people’s experiences.

I want to mention “Future in mind”, which is the blueprint we published in March 2015 just before the coalition Government came to an end. It was widely welcomed across the sector. We involved educationalists, academics, practitioners and young people, in particular, in the work we did. Central to the recommendations was the role of schools, and among the recommendations was the proposal that there should be a specific individual responsible for mental health in every school to provide a link to the expertise and support available, to discuss concerns with an individual child or young person and to identify issues and make effective referrals.

There should be someone taking responsibility but also a named contact point in specialist mental health services—too often we find that schools do not have the faintest idea who to contact when a child needs support—and also joint training. The hon. Member for Upper Bann (David Simpson) made the point about the training of teachers. If we can get teachers working alongside specialist mental health workers in schools, everybody will benefit.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Will the right hon. Gentleman also pay tribute to the work of the Samaritans? It has a scheme called DEAL—developing emotional awareness and listening—which it is rolling out across Wales in particular. There is a resource pack available for teachers if they want to take it into schools, or the Samaritans will send volunteers into schools to undertake, separate from the school system, talks and raise awareness for young people. That is the sort of low-cost—not expecting lots of money to be involved—involvement of people and organisations such as the Samaritans, with their specialist knowledge and awareness, that is extremely helpful in reaching young people.

[Norman Lamb]

I pay tribute to the hon. Lady for the incredibly valuable work that she has done, particularly on suicide. I join her in paying tribute to the work of the Samaritans and the army of volunteers who give up their own time to save people’s lives. The sort of initiative that she described is incredibly important. Do the Government remain committed to implementing “Future in mind”? There is a danger in Government that we just replace one initiative with another. There is a very good plan there, which has all the right principles, and the important thing is just to do it and make sure that the money—I will come to that in a moment—actually gets through to where it is required.

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb) for the opportunity to have this debate. As chair of the all-party parliamentary group on suicide and self-harm prevention, one thing of which I am very aware is that change only comes when there are champions, at the local and national levels. He has certainly been a champion in this House for mental health. When he was a Minister, it was always a delight to speak to him, because I knew I was talking to somebody who understood the problem, and I pay tribute to that.

I welcome the publication of the latest national suicide prevention strategy—I am particularly pleased by its recognition of the work of the all-party group—but one of the big problems is that there is no new money for local action plans. If we do not start on a local basis, we will not get the change that all of us want.

The all-party group works only with academics; on the whole, the people who come to speak to us come from an academic background. Their work is fully researched, and the way forward is understood. Just before Christmas, two researchers from the National Centre for Social Research, Sally McManus and Caroline Turley, addressed the all-party group. They discussed the findings of the recently published adult psychiatric morbidity survey, which examined trends in mental health and well-being since 2000.

It was extremely depressing. One of the first things that they mentioned was self-harm. The all-party group considers both suicide and self-harm prevention, because self-harm is often an early indicator that someone is suffering from mental health problems. If we ignore it, we just build up problems for the future. Self-harm among 16 to 24-year-olds has doubled since 2000. One in four women and girls aged 16 to 24 have self-harmed, rising to one in three among over-18s. In 2000, one in 15 young women between 16 and 24 reported having self-harmed. By 2015, that figure was one in five.

Young women are twice as likely as young men to self-harm. They do so for a number of reasons, but it is often to relieve tension, anxiety and depression. For them, it is a coping mechanism. Triggers vary from one individual to the next, but bullying via social media, low self-esteem and anxiety are often cited. Some care must be taken in considering those figures, as the rise might be due to increased willingness to report, but the increase is borne out by other studies. Clearly, that level of distress cannot be ignored.

Of the 16 to 35-year-olds surveyed, one in 10 asked for help but did not receive it. Someone aged 16 to 18 with anxiety and depression has only a one-in-five chance of accessing help. The older someone is, the more likely they are to receive help. Some 37% of those who reported having self-harmed had received medical or psychological help, leaving two thirds who had no help. If an individual presents at hospital after an incident of self-harm, they will not necessarily receive the help that they need.

The highest rate of access to help was among 35 to 54-year-old white British women. If young people come from a black or ethnic minority background, their access to mental health support decreases. That is incredible and totally unacceptable. Findings published recently in The BMJ, drawn from the multi-centre study of self-harm, 2000 to 2012, considered hospital admissions for self-harm and concluded that despite NICE guidelines, only a little over half were offered a psychosocial assessment.

Sadly, another issue that we must consider is that all too often the criminal justice system picks up the failures of the mental health services. Too many young people are sidelined into youth offending teams and ultimately into young offenders prisons. Staff at those young offenders prisons have told me that some of the most tragic cases that they deal with are of young people with mental health problems who are being criminalised at an early age. That has to stop.

The Department of Health is diverting its failures to the Home Office and to the Ministry of Justice. I cite as an example a young girl in my constituency who, very sadly, has quite severe mental health problems. Over the years, she has appeared in front of the police and the courts more than 140 times. She has served numerous prison sentences; she is in and out of prison all the time. The police and the probation service recognise that her problems are linked to mental health. She has been involved in the mental health system since she was a very young child, but now that she is a young adult, she is being sent back and forth in the criminal justice system and is not receiving the mental health support that she needs. She is now out again; she has already tried to take her own life by jumping from a bridge and has broken her ankles. The likelihood is that she will be back in prison before we know what we are doing.

I agree that we need to start early. The work in schools is essential. Young people need to know what is normal—“I’m going through adolescence, my hormones are all over the place; what is normal and what is actually a problem that needs dealing with?” We need to look at NICE guidelines on psychosocial assessments, which need to be in place more often. The Department of Health informed me in response to a parliamentary question that it does not keep records on where a psychosocial assessment has been offered, but that would give us an idea of how often we are failing.

Another important thing that needs to happen is a triage system. For a GP’s letter to a consultant asking for an appointment to just sit on a secretary’s desk until the secretary has done that assessment is nonsense. Dr Robert Colgate has set up a triage system for mental health that allows direct access to a consultant, so that help and support are available to GPs, mental health nurses and psychiatric social workers straight away and medication, help and appointments can be given straight away.

This has gone on too long. We know what the problem is, and it needs money and investment. Let us make sure that we start from today.

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[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), his colleagues and the Children’s Society for initiating this debate. As ever, I pay tribute to his continuing personal commitment to improving mental health services, not only as my predecessor but also through chairing the commission on children and young people’s mental health for the Education Policy Institute. That work has been extremely valuable to us.

The right hon. Gentleman is quite right to say that today’s debate is both timely and hugely important. As many colleagues have demonstrated in their comments, we know the distress that mental health problems cause to individuals and those who care for them. Some 10% of children have a diagnosable disorder—700,000 in the UK—and they are twice as likely to leave school with no qualifications, four times more likely to become drug dependent and 20 times more likely to end up in prison. He could not have put it better. There is a compelling moral, as well as social and economic, case for change. We know that if we can get our children and young people the help and support they need early on, when problems first arise, we can make sure that the problems do not become entrenched. That is why the Prime Minister was clear in her determination to improve mental health services and tackle the burning injustice of those with mental ill health having a shorter life expectancy.

As has been discussed, the measures announced by the Prime Minister particularly tackle children and young people’s mental wellbeing and build on the substantial work already in train to implement “Future in mind”. We will continue that work, so that we can go further and faster in intervening earlier more often. In driving those reforms forward, one of the challenges we still face—the right hon. Member for North Norfolk identified this when he was a Minister—is the “fog” when trying to identify and pinpoint the best treatment and support for those with mental health problems. We need to base policies on the most robust evidence possible, so that we can be sure that we are providing the care that people need at the right time and in the right way.

That is why the Department for Education is conducting a large-scale school survey on the activities and approaches used in schools to support children and young people’s mental health in order to find out what works best, and why the Prime Minister requested that the Care Quality Commission undertake an in-depth thematic review—the first of its kind. That is also why we are carrying out a prevalence survey on children and young people’s mental health—the first since 2004, which was before YouTube, Twitter or Snapchat. The survey will look at issues such as cyber-bullying and the impact of social media for the first time, and it is on course to report in 2018. It will fill an important gap in our understanding.

As the right hon. Member for North Norfolk knows, I believe very strongly that transparency in mental health services has lagged behind that in acute services. At a national level, data on children and young people’s mental health services were included in the new mental health services data set for the first time in January. It is still early days, but as collection improves, new metrics to monitor delivery are becoming available. We know from experience in acute services that that does improve accountability, standards and safety for patients. I will respond in detail to the comments of the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley) about her letter—I do not have time to do that properly right now—but we are looking at how we can drive accountability, eradicate all shadow of confusion from clinical commissioning groups about how they should be reporting, and make sure that we get that data set exactly right. As recommended by the taskforce, we will publish a 10-year research strategy to ensure that the evidence-gathering is sustained. A new policy research unit for mental health will be established in 2017 to make sure that the research continues to become a reality.

While all the evidence-gathering is going on, we cannot stand still. That is why we will press ahead with the implementation of “Future in mind”. As the right hon. Member for North Norfolk said, some areas are performing well and improving, some need to get the message about why this is important, and others are coming from such a low base that they are still working on capacity building, so we are not seeing evidence of improvement yet, but we are clear that we are ambitious not only to deliver “Future in mind” but to go further upstream and intervene earlier to prevent problems. The evidence base that we are building will come together to support the publication of the Green Paper, with increasing focus on preventive activity across all delivery partners. The Prime Minister committed initially to a new focus on schools, colleges and local NHS services working more closely together to provide dedicated children and young people’s mental health services. We are supporting schools and the NHS to develop work by evaluating models and approaches and exploring the impact that closer working can have. We will initially support that by funding the provision of mental health first aid training for teachers in secondary schools—we know that that works. That is our start. I am going to do the training in the next few weeks, to see exactly why it works.

As we know, the Prime Minister also launched a refreshed programme of activity on peer support in schools and online to help young people, through providing access to well-trained mentors, as well as comprehensive support structures to help identify issues and prevent them from escalating.

[Mrs Moon]

I urge the Minister to make sure that the Government look at best practice across the devolved Administrations. It is not a case of reinventing the wheel; let us look at what works elsewhere and incorporate that.

[Nicola Blackwood]

Absolutely. We are also looking at increasing support for schools by finding the evidence of what is proven to work in their approaches to mental wellbeing. That will be achieved by a programme of randomised control trials of promising preventive programmes across the country. As the hon. Lady also mentioned, the refreshed suicide strategy has a particular focus on self-harm, which is causing so many problems in schools.

To make the measures work and to see the progress that we so desperately need, we have to work closely with colleagues across Government. As colleagues have said, schools and colleges have an important role to play in supporting children and young people’s mental health. That role is not only laid out in statutory safeguarding guidance but is one of the four areas of Ofsted judgment in the new common inspection framework.

Colleagues are right: if we are to expect schools to play this role, we must give them the right training and resources. In 22 pilot areas, which include 255 schools across the country, NHS England has been trialling a single point of contact in schools. That programme has tested improvements in joint working between school settings and specialist mental health services—particularly improvements in local knowledge and identification of mental health issues—and it aims to develop and maintain effective local referral routes to specialist services to ensure that children and young people have timely access to specialist support where required. It is also testing the idea of a lead contact in schools and specialist mental health services and examining how different areas choose to put that into practice. The work is being independently evaluated by Ecorys, and the final report will be available in the spring. The question is whether that system is more effective than having an individual counsellor in every school. We are looking at that.

Other support available includes Government-funded PSHE Association guidance, and lesson plans on how to teach mental health across all four key stages. A range of training on how to recognise specific mental health issues is available to all professionals who work with young people through the MindEd website; our analytics have shown that teachers are the largest single group of registered users on the MindEd tool. As the shadow Minister said, mental health and wellbeing is an evolving and vital area of education, and we need to make sure that it is fit for children growing up in modern Britain, so the DFE is looking again at the case for further action on PSHE and sex education provision, with particular regard to improving quality and accessibility. I am sure that it will keep the House updated on that.

The right hon. Member for North Norfolk is absolutely right that school counselling can turn around a child’s whole life trajectory, so schools are encouraged to provide counselling services, and the DFE has produced guidance on good school-based counselling as part of a whole-school approach to wellbeing. It has also published advice on behaviour and mental health, which provides teachers with information, and with tools to help them identify pupils who need help and to give effective early support in understanding when a referral to a specialist mental health service may be necessary. An advisory group, including sector experts and young people, looked at what good peer support for mental health and wellbeing looks like and considered how to encourage good practice in schools, community groups and online. There is much greater recognition that the earlier we pick up these things, the better it is for young people and their mental health.

The “Children and Young People’s Mental Health: Time to Deliver” report from the right hon. Member for North Norfolk found that we are making progress in many areas of the country, but not nearly enough to be complacent. I agree completely with that. We are restless in our ambition not only to drive delivery of “Future in mind” in all areas, but to go further and deliver upstream interventions to prevent problems, rather than waiting until the need for treatment. I hope that I have convinced the right hon. Gentleman that this is an area to which we are fully committed, and that we will continue to drive forward with his agenda.

Question put and agreed to.

Resolved,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

Mental Health and NHS Performance

Madeleine Moon Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I went to Addenbrooke’s in the autumn and saw at first hand how hard the staff there are working. That is another trust that is in special measures, but it has made huge progress in trying to turn things around. I met several staff in the emergency department as well, and I pay tribute to them for their very hard work. I have never said that it is not about funding; what I say is that it is not just about funding. There is huge variation. In parts of the country, emergency departments avoid precisely the kind of overcrowding that the hon. Gentleman described at Addenbrooke’s. Hospitals that do that very successfully include Luton and Dunstable. We need all hospitals to adopt what the best hospitals do.

[Mrs Madeleine Moon (Bridgend) (Lab)]

I welcome the publication of the new suicide prevention strategy, and I welcome the fact that it includes self-harm. I am also grateful for the mention of the work of the all-party group on suicide and self-harm prevention, which I chair. Will the Secretary of State meet Dr Robert Colgate? He has set out a triaging system for mental health, which means that people do not have to wait six to nine months to see a consultant. With the support of frontline staff, they can get an immediate triage assessment and assistance for their condition. Will the Secretary of State meet urgently Dr Colgate, whose work is being peer reviewed by the University of Manchester, to look at how his system, which is being rolled out throughout England, can help us to tackle the problems we have?

[Mr Hunt]

I thank the hon. Lady for her work on the all-party group. I am more than happy to meet Dr Colgate. The purpose of the refreshed suicide prevention strategy is to try to ensure that we adopt best practice throughout the country. Some areas of the country are doing a very good job in suicide prevention, particularly in co-opting the public so that they understand that they can make a difference, too, but I am happy to explore with the hon. Lady what more can be done.

Social Care

Madeleine Moon Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

I agree, and that is why I started my speech by saying we should value the job our care staff do and we should train them properly; it should be a proper job with a proper career path. The care staff I met today were reduced to worrying about what they were being paid, however, simply because they were paid less than the minimum wage.

This is what six years of funding cuts to social care actually mean for people who need care and their carers: unmet needs for care; patients stuck in hospital, increasingly because they have to wait for a care home or a nursing home place; poor care in care homes, with one quarter of “inadequate” services unable to improve; poor home care, with more complaints being upheld by the ombudsman; more unpaid family carers having to step in to care; more unpaid family carers having to provide increased levels of care; and, without the right support, those family carers becoming isolated, burnt-out and unable to look after their own health. That is a disturbing deterioration in the state of social care. I want the Secretary of State to tell us whether he recognises the scale and seriousness of the issues I have outlined.

[Mrs Madeleine Moon (Bridgend) (Lab)]

As chair of the all-party group on Parkinson’s—and motor neurone disease—I have had repeated complaints about the 15-minute calls that local authorities are being forced to introduce because of cuts in their social care allowance. They mean that people are neglected: carers literally run in, and, if the person cannot communicate or has poor mobility, the quality of their care is appalling.

[Barbara Keeley]

It is indeed. There are many examples of that, and we have debated them here many times. The funding crisis is at the base of all this.

I repeat what I said at the start of my speech: social care is in crisis due to a lack of funding. It is notable how many leading doctors, health experts and organisations involved with the NHS are now expressing their concerns and fears about social care and the lack of funding for it. Here are some of those people: Simon Stevens, chief executive of NHS England; Miss Clare Marx, president of the Royal College of Surgeons of England; Professor Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges; Dr Suzy Lishman, president of the Royal College of Pathologists; Professor Carrie MacEwen, president of the Royal College of Ophthalmologists; Professor Neena Modi, president of the Royal College of Paediatrics and Child Health; Professor David Oliver, president of the British Geriatrics Society; Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists; Professor Sir Simon Wessely, president of the Royal College of Psychiatrists; Dr Anna Batchelor, dean of the Faculty of Intensive Care Medicine; Dr Liam Brennan, president of the Royal College of Anaesthetists; and Professor Jane Dacre, president of the Royal College of Physicians. All those people have expressed their fears and concerns about social care and the lack of funding for it.

I should like to add to that list some of the organisations working in the NHS and social care that are now expressing their serious concerns about the funding of social care. They include: the King’s Fund, the Nuffield Trust, the Health Foundation, the Local Government Association, the Association of Directors of Adult Social Services, the County Councils Network, the BMA, Care England, Unison, Age UK, the Alzheimer’s Society, the British Red Cross, Carers UK, Independent Age, United for all Ages, the Learning Disability Coalition, the Motor Neurone Disease Association, and the Care and Support Alliance. Those people and those organisations share a belief that the Government must act now on social care funding, and I urge hon. Members on both sides of the House to support our motion and vote to save social care tonight.

Land Registry

Madeleine Moon Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Lammy]

My hon. Friend makes an excellent point. In these troubled times, when confidence in this House and in major political parties is at a low ebb, it is important to recognise the institutions that the public hold dear, of which the Land Registry is certainly one. As a former Minister who had responsibility for the Land Registry, I am well aware of the valuable roles it plays.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Does my right hon. Friend think that the privatisation proposal has been driven by a desire to maintain the professionalism, integrity and impartiality of the Land Registry or by a petty desire for a short-term and dangerous input of cash to the hard-pressed Treasury? Which is it?

[Mr Lammy]

I have a feeling that my hon. Friend is clear about which side of the argument she is on. This Minister is not a bad man. so we will be interested in what he has to say—and which side he will pick in the forthcoming leadership battle.

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[John Stevenson]

The Land Registry does make a profit, and it is quite rightly trying to modernise. It also continuously develops its programmes, and all conveyancers are aware of that.

Like many other practitioners, I acknowledge that the Land Registry plays a vital and central role in the property market. Practitioners greatly value and respect the services that it provides. As a legal practitioner, I see the worth of the Land Registry and its services. We should also not forget the many skilled people who work for the Land Registry, all of whom ensure that the legal profession, the owners of land and the financial institutions are well served.

As a Conservative politician, not unsurprisingly I believe in a market economy, in competition and in competitive markets. I have absolutely no issue with the privatisation of businesses or industries, as I firmly believe that, more often than not, private sector ownership leads to greater efficiency and innovation and better value for money for the taxpayer and the consumer. I do, however, believe in a strong liberal democracy, in the importance of the rule of law and in the significance of property rights in a market economy—in this case, the rights relating to the ownership of land. We must therefore tread very carefully when considering the future ownership of the Land Registry, given its central role in the property market.

The Land Registry is at the very centre of land and property rights in this country, and the integrity of the system is critical. Its importance is such that all solicitors, property owners, leaseholders, lenders and financial institutions must have complete confidence in its integrity, openness and honesty. It has to be trusted. Any doubts or concerns about its integrity, about possible conflicts of interest or about misuse of information could affect this central part of our capitalist system. We must also recognise the fact that the Land Registry is a natural monopoly, a bit like the police or other institutions that do not lend themselves to competition. Such monopolies, which are of great importance to the very fabric of our system, must be treated with great care.

[Mrs Moon]

A considerable number of my constituents work in the Land Registry in south Wales. Their concern is that they constantly have to adapt their practice on the basis of new policy guidelines from the Government. They work within an overarching public interest requirement, and they are worried that that ability to adapt will go if there is a constant need to renegotiate contracts and seek changes with a private sector company. How can we keep that integrity for my constituents if we have to factor in the profit motive of a private sector company?

[John Stevenson]

The hon. Lady raises an interesting point about the constant changes in the Land Registry. As practitioners, we have to deal with those changes as new rules are put forward by this place in relation to the Land Registry and other aspects of property transactions.

As I have said, the Land Registry is central to our property system in this country, and it is vital that it has absolute integrity and openness. It has to be trusted.

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[Mr Jenkin]

That is exactly the point. The former communist state had destroyed the old records to create a new order.

I have no objection in principle to privatisation, which has been a successful means of transforming large parts of the former public sector. Even the Labour party would have absolutely no intention of returning large parts of what is now in the private sector to the public sector.

Transforming the Land Registry into a modern, digitally-based service is crucial for making it more efficient and responsive to user needs. So far the digital transformation has been extremely slow. I have three main concerns about the present proposal. I hasten to add that I am speaking on my own behalf; this is not an agreed statement by my Committee. The Land Registry must continue to operate as an essential public service, the future owner of a privatised Land Registry must be committed to providing long-term stability, and the final deal, if there is one, must fulfil the Government’s own stated objectives for the use of open data.

In a submission to the Government’s consultation, I recommended that the quality of service provided to the public by the Land Registry must be prioritised above realising capital gains or transferring risk from the Government’s balance sheet. The primary concern must be to ensure that an accurate record of land use and ownership is maintained in public hands. The Land Registry’s core services should be protected from any real-terms price increases, and their quality must not suffer as a result of any transfer of operations to the private sector. The Land Registry is, and will remain, part of our critical national infrastructure. Its protection is crucial, and any public-private model or privatisation model must put in place safeguards to prevent the service being disrupted in the event of bankruptcy or commercial failure of any kind.

Our report in 2014 was based on evidence from leading figures in the world of data management and statistics, as well as from Ministers. Although the Committee did not look in detail at the privatisation of the Land Registry, we did look into the future use of the Government’s major datasets, of which the Land Registry is one. The final report made several recommendations for the use of Government data. In particular, we stressed the need to ensure that datasets are easy to access, easy to read and free to use.

On the specific subject of the Land Registry, the Committee concluded:

“A radical new approach is needed to the funding of Government open data. Charging for some data may occasionally be appropriate, but this should become the exception rather than the rule. A modest part of the cost to the public of statutory registrations should be earmarked for ensuring that the resultant data . . . can become open data.”

Data held by the Land Registry are one such example. If this model is adopted by the Government, they must not allow a new privatised entity to expect to make money from the selling of those data. The expectation must be that the data will be freely available.

In public policy terms, it is important to understand the value of open data to the economy as a whole. Research commissioned by the Open Data Institute found that public sector open data will provide more economic value every year, equivalent to as much as 0.5% of GDP, than data that users have to pay for. For example, we all use the Postcode Address File. That has been privatised, but what makes it of such value to us is that we can get on a website and get it free. How outrageous it would be if we had to pay for that.

Unfortunately, when the Royal Mail was sold, we transferred those data to the private sector and now big businesses have to pay to use those data. The result is that new forms of open source data will be created, which will gradually take over from the Postcode Address File. By transferring those data into the private sector as we have, we have undermined their value and created a cost to the productive sector of the economy for accessing them. In our conclusions, we stated that the sale of the Postcode Address File was the wrong decision. We concluded that such an asset should have been kept in public ownership, where it would be a national asset, free for businesses and individuals to use for the benefit of the wider economy.

If the Land Registry is privatised, the land register itself—the actual data—must stay in public ownership. It is crucial that the Government preserve for themselves a substantial degree of policy flexibility with regard to any agreement made with a privatised organisation, and if they decide that the public interest is best served by a change in data policy, they must remain free to effect this and to do so without excessive cost.

I am deeply concerned that the future owner of a privatised Land Registry must be committed to long-term stability and continuity. That depends on the character of the operator, if there is to be a private sector operator. The operator should understand that it may derive profit only from some kind of long-term yield for a long-term contract with the Government and be prepared to invest in the organisation to achieve this aim. An investor with a more venture capital-style approach, aiming to make a capital gain out of the development of the business and then on-sale, would be a completely inappropriate form of ownership.

[Mrs Moon]

Given all that the hon. Gentleman has said about the importance of the integrity of the Land Registry, why is it not appropriate to build that flexibility for entrepreneurship into the current Land Registry so that it can make the profit that is necessary for the investment and modernisation that are needed? Why do we have to take this risk?

[Mr Jenkin]

I shall come to that. It is a perfectly reasonable question.

The type of owner of the infrastructure might be like the banks automated clearing system, which is a company that is owned by the banks. It is just an operating company that the banks fund in order to provide them with a service. That is much more the kind of privatisation that I would find acceptable, rather than a company called Land Registry plc, with its own board of directors thinking about how to develop its business. It is a service and there is a function that it needs to provide.

The final proposal should include a full assessment of what has happened in other countries where such a service has been transferred to the private sector. Additionally, in any privatisation plan the Office for National Statistics should have the power to take over the collation and publication of Land Registry data, effectively getting a daily feed from all new records and publishing them free online. If the Government decide to proceed with some kind of privatisation of the operations, in two years’ time I expect to be calling the Department for Business, Innovation and Skills and UK Government Investments, which is overseeing the process, to discuss with my Committee what effect this movement has had on the publication of open data.

Finally, in answer to the hon. Member for Bridgend (Mrs Moon), I hope the Government will explore alternative means of doing that by keeping the Land Registry in the public sector. Let us face it: it is only silly Treasury rules that prevent very cheap public money from being put into this with public sector involvement, but keeping it in public ownership, in order to develop the customer-responsive and properly capitalised system that we want. My mind is open, provided the data remain in public hands. My mind is open, provided the arrangement is stable, but I would not rule out transferring the service to some mutual or some existing consortium of banks or insurance companies or even keeping it in the public sector.

Hand Hygiene: NHS

Madeleine Moon Excerpts

Wednesday 13th January 2016 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Alan. I commend the hon. Member for Amber Valley (Nigel Mills) for calling the debate. It is such a simple issue. We are taught from early childhood to wash our hands, and yet somehow it seems to get lost. It seems to have disappeared out of our daily practices. We are failing on one of the easiest ways of addressing so many conditions that are costing this country a huge amount and causing the NHS a terrible problem.

We are told every day whether we should take vitamins or whether we should drink red wine, which is either good for us or destroying our lives, and we are told what superfoods to eat, but a simple, life-changing thing that can be added to the daily routine is washing one’s hands on a regular basis. It is one of those bizarre things that came up during a quiz. The question was, “What is the fastest thing that a human being can do?” and the answer was sneezing. Apparently, a sneeze comes out at 100 mph and can spread across a huge area. Most people catch it in their hands and do not then think to wash them. We all know about washing our hands after going to the bathroom, but we somehow cough and sneeze into our hands and pass diseases on, particularly to those who are vulnerable, in the most frightening of ways.

Globally, poor hand-washing leads to 600,000 deaths a year. Another horrible statistic is that 28% of commuters across the UK have faecal bacteria on their hands. I dread to think who found that out and how they did it, but there we are. It takes just 30 seconds of washing to stop an infection being passed on to someone else and it can make huge difference. In Europe alone, 25,000 people a year die from infections resistant to antibiotics. Resistance to antibiotics is on the global agenda and hand hygiene is a way that we can actually reduce our dependence on antibiotics and prevent common illnesses such as food poisoning.

I want to bring to the Minister’s attention today a deeply concerning condition that sadly not many people seem to know about, but hand-washing really can make a difference to it. CMV, or cytomegalovirus, is a common virus that can infect anyone. Most people will not know they carry it, but if a pregnant woman contracts the virus, she can pass it on to her unborn child with catastrophic results. Almost 1,000 children are affected by the condition every year. CMV can cause miscarriage or stillbirth. Five out of 1,000 babies will die in their first year of life, and two to three babies a day are damaged by CMV, which was identified in 1956 by the same research team that discovered polio, mumps and rubella. There is no vaccine to deal with it, but we can prevent passing it on simply by washing our hands.

CMV is responsible for 25% of childhood hearing loss, as well as for vision loss, physical impairment, ADHD—attention deficit hyperactivity disorder—behavioural and learning difficulties, and cerebral palsy. It is passed on by bodily fluids, mainly saliva and urine, often from small children. It is battled simply by washing hands in soap and water and by getting parents to understand that they must not share food, cutlery or drinks with their children. No parents, I hope, would think of changing a child’s nappy without washing their hands, but how many parents wipe a child’s nose without thinking to use a handwashing sanitiser or washing their hands? Parents should ensure that they wash their hands both before and after feeding a child. Those are simple ways to prevent dramatic changes.

Hand-washing can prevent diarrhoea, vomiting, food poisoning, the norovirus and MRSA. It is a simple way to change infection rates. We could save the NHS huge amounts of money. I am pleased that nurses are very conscious of it, but we almost need to have every patient watching for other people’s visitors and ensuring that they use the antibacterial washers as they enter the ward. The statistic mentioned by the hon. Member for Amber Valley—one in 16 patients acquires an infection—is horrific. That is not something that on the whole doctors have to combat; it is something that every one of us as patients, visitors and fellow citizens should take responsibility for tackling. I am delighted that we have had the opportunity to raise the profile of the issue today.

Specialist Neuromuscular Care and Treatments

Madeleine Moon Excerpts

Tuesday 15th December 2015 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I want to speak not so much about Duchenne muscular dystrophy as about Parkinson’s disease and motor neurone disease—particularly the latter, which is also a neuromuscular condition. I will consider the problem of getting appropriate diagnosis and in-care support from neurologists. That is critical. We have already heard about the difficulty that those living in the wrong part of the country have in obtaining a quick diagnosis and the right support as they progress through the condition.

Neurological disorders account for up to 20% of acute medical admissions, and there are more than 60 different neuromuscular conditions. I was helped to understand the patchwork problem that people experience in getting access to neurological advice, support and guidance by a report commissioned in 2014 by the Association of British Neurologists. With 60,000 to 70,000 people in the UK living with a neuromuscular condition, there is considerable pressure on neurologists, and on specialist diagnosis and support. In 2011, a joint report of the ABN and the Royal College of Physicians, “Local adult neurology services for the next decade”, recommended that all relevant patients be admitted to hospitals that had an acute neurological service led by consultant neurologists. We are nowhere near that position now.

In 2014 a survey by the ABN found that the likelihood of a patient with a neurological problem being seen by a neurologist varies dramatically depending on where they live. The availability of a neurological review varied according to the type of hospital the patient was admitted to—whether it was a neuroscience centre, a neurology centre or a district general hospital, with or without neurological support. It was significantly better to be seen at a neuroscience centre, where there was support on 91% of days. Those who went to a neurological centre got support from a neurologist on only 80% of days. District general hospitals with a neurologist based at them had access to a neurologist on only 58% of working days. In contrast, access for patients at district general hospitals with no resident neurologist was available on only 32% of days. That is totally unacceptable, when we know that access to such neurological support dramatically changes the impact on a patient; there is an effect on their capacity to continue their life, and on their prospects of being discharged from hospital with a good quality of life.

I am concerned about the fact that access to CT and MRI imaging varies between hospitals. MRI was available 24/7 at only 30% of sites in the UK. The 2014 study identified a wide variation in access to specialist services for patients presenting with acute neurological disorders. As liaison neurology services change the diagnosis and management of a high proportion of patients, improving outcomes and reducing length of stay, there is an opportunity to improve both patient care and cost-effectiveness.

The all-party parliamentary group on motor neurone disease recently heard emotional and dramatic evidence from Mark and Katy Styles. Mark worked in local government and Katy was a secondary school teacher before she gave up work to become Mark’s full-time carer. Mark has a form of motor neurone disease called Kennedy’s disease, which is slowly progressive and genetic, passed from mothers to sons. He lives in Canterbury, and they have to travel to University College hospital in London to see a neurologist. That is nonsensical. Support should exist locally, because his condition may soon deteriorate to the extent that he cannot access the neurological support that he and his wife need. When Katy was working, she earned £150 a day. She now gets £67 a week to provide the on-duty, 24/7 care that her husband needs. We must recognise the invaluable work of carers and ensure that they get the necessary support.

Some 30% of people with motor neurone disease will die within one year of diagnosis. It is absolutely critical that they get rapid access to help and support for their condition. I will not repeat all the words that have been said about access to wheelchairs, but I stress that if someone with MND has the wrong wheelchair, they may not be able to communicate that. An ill-fitting wheelchair causes acute pain, but MND sufferers rapidly lose their speech and the ability to move their hands and upper limbs. They cannot communicate that they are in pain or distress, so the provision of wheelchairs is critical.

The APPG commissioned a report last year called “Condemned to Silence” about access to communication support. The issue is not money, because the Government have put money in place for communication support; it is poor roll-out, and something must be done to improve it. I look forward to hearing from the Minister what steps are being taken to ensure that people are not condemned to die without access to communication support, which they need to talk to their loved ones and carers about their needs, and to avoid suffering the indignity of being unable to communicate if they are admitted to hospital.

I have two final points. First, access to care support is critical as conditions deteriorate. People cannot wait for further assessments, or be put on waiting lists for care support, when they often need double-handling care support. If people are not to be condemned to lie in beds, support must be available immediately. Access to hoists and high-low hospital beds is often delayed. We must get faster at providing them. Secondly, access to finance to research such conditions is vital if we are to give families hope, and a sense that time and research will give them—and perhaps family members, who may inherit a condition—a better life in the future.

Mental Health

Madeleine Moon Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Bradshaw]

My hon. Friend is absolutely right. I hope that the Minister heard her intervention, because I will leave that bit out of my speech. I was going to raise the ongoing problem of the interface between mental health services for young people and adolescents and those for adults. A lot of people are falling through the gap.

There has been a lot of talk, including from the Government, about parity of esteem, but there is scant evidence of it on the ground at a local level. I ask the Minister to explain when he responds to the debate why, if the Government are serious about parity of esteem, NHS England has removed it from this year’s NHS mandate. That is the important document that the NHS publishes every year to tell local health services what they have to deliver. Why has parity of esteem been removed?

Why are the Government cutting so drastically the funding for public health, which delivers many preventive services, such as alcohol and drug treatments and psychological support for young people in schools, that stop people getting ill in the first place, saving money and lives?

As we have heard, after years of falling, the rate of male suicide is on the increase again. Suicide is the main cause of avoidable death among young males.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Would my right hon. Friend like to attend a meeting held by the all-party parliamentary group on suicide and self-harm prevention and the all-party mental health group, at which Dr Robert Colgate will address us on the subject of triaging? By that process, mental health nurses, social workers and GPs can triage a patient for whom they cannot get an immediate appointment and enable appropriate care plans to be put in place while they wait for the next-stage appointment. The meeting is on 29 January, and I hope that my right hon. Friend will join us.

[Mr Bradshaw]

I am sure that hon. Members will be grateful for that public invitation in spite of the pressure on their diaries from numerous all-party parliamentary groups.

Yesterday, the Health Select Committee was told that, whereas the vast majority of acute hospital trusts were expecting to run deficits this year—a big increase— the figure for mental health trusts was much lower. We might think that that is a good thing, but the reason that acute trusts are running such big deficits is that they are giving priority to ensuring safe care. So, if far fewer mental health trusts are running deficits, is that because they are simply cutting services? I should be grateful to hear the Minister’s view on the difference between the deficits being run by mental health trusts and those run being by general acute hospital trusts.

I shall close now, because many people want to speak in the debate. There is probably no one here or outside the House who has not been affected, or whose family has not been affected, by mental illness. We have been hearing warm words from the Government for several years about how things will improve. Indeed, we have heard today that they are improving, but that is not the experience of people on the ground. So I hope that, when the Minister responds, he will focus on action and delivery and not just on words.

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[Simon Danczuk (Rochdale) (Lab)]

It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I am very grateful for this debate, as the issue is very close to my heart. It is vital to ensure that everyone has access to the best mental health services. As the Secretary of State pointed out, one in four of us will face some form of mental illness over the next year, but figures from the mental health charity Mind suggest that 75% of those with anxiety or depression get no treatment at all. It is vital that we start taking mental health more seriously, starting with adequate funding and giving mental health the parity with physical health that it deserves.

I wholeheartedly support a protected NHS budget. The most effective treatment of mental health issues, however, is seen at local level in communities. A protected budget means little when funding to mental health services at local level is being slashed. Those in need reach first for their local services, yet the scale of cuts, particularly to local councils, is having a direct and detrimental effect on services that are crucial to helping many people deal with their mental health problems.

The Royal College of Psychiatrists states that a key part of mental health services is good public health funding, yet only 1% of public health spending is focused on mental health. That will be compounded by the fact that the money given to councils for public health will fall by 3.9%, year on year; that will be an 18% fall by the end of this Parliament. If we are committed to ensuring parity of esteem between mental and physical health, that is simply not good enough.

[Mrs Moon]

My hon. Friend may be aware that last year the all-party group on suicide and self-harm prevention conducted a survey of local authorities to see how many had suicide prevention plans and suicide action groups in place. A large proportion did not have any action plan or any groups working on suicide prevention. Is that not something the Government must address if we are to move forward?

[Simon Danczuk]

My hon. Friend makes a really important intervention on an issue that I was not aware of. The Government should impress on local areas the need to ensure that those things are put in place.

I want to discuss suicide. I pay tribute to the right hon. Member for North Somerset (Dr Fox), who is no longer in his place, for making an excellent speech, not least as regards suicide. It is a particularly important issue in Rochdale, where suicide rates continue to remain above the national average. In our town, the rate is 11.8 per 100,000 people per year; that compares with a rate of 8.9 per 100,000 for England as a whole. The male suicide rate in Rochdale is 18.6 per 100,000, which dwarfs the 14.1 per 100,000 for England as a whole. Those figures show a large rise from 2010, when they were 14.7 in Rochdale and 13.3 in England. Put simply, more people are killing themselves in Rochdale.

Our council, like many others up and down the country, is faced with daunting cuts to its budget. The result in Rochdale is that the council is considering removing funding to the tune of just £20,000 for the award-winning Growth Project. This project works to provide a safe and supportive haven to those with mental health issues on a number of allotments. The work done by the Growth Project has a proven track record of improving individuals’ wellbeing. It promotes good mental and physical health through outdoor activity in a green environment, and participants can literally see the fruits of their labour. To date, the project has 88 beneficiaries, and it embodies the essence of equality for mental and physical health. Although the project is run by a voluntary organisation, fighting mental health issues must not be seen as an act of charity; it is about justice and necessity.

If we are truly to achieve parity of esteem for mental and physical health, it is exactly projects such as the Growth Project in my constituency that will need funding. They do not need to be cut because of pressure on council budgets.

Male Suicide and International Men’s Day

Madeleine Moon Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I very much agree. I hope that this will be part of a move towards a day when men’s issues are treated in this House as being as important as female issues. If that is what my hon. Friend is saying, I am all for it, and I hope that this debate helps us move towards that.

The motion that we are debating today, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) pointed out, specifically mentions male suicide. I want to deal with that subject in particular, as suicide is desperately sad and it is clear that more men than women take their own life each year. In fact, the figures show that around three quarters of all people who commit suicide are men. I would like to place on record the fact that although men are more likely than women to commit suicide, those left behind grieving will be of both sexes and often children.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Can I point out to everyone in the room, please, that no one in this country has committed suicide since 1961, when suicide was no longer a crime? People “commit” murder, burglary or arson, but they do not “commit” suicide. They take their own life, but they do not “commit” suicide—“commit” is a word that relates to a crime, and suicide is not a crime.

[Philip Davies]

I am grateful to the hon. Lady for picking me up again. The terminology may be important to some people, but if I am going to be chastised for using the word that, as far as I can see, is used by every member of the public whenever they discuss this issue, I do apologise. But let us not get bogged down in politically correct terminology. I would much prefer that we dealt with the issue that I am trying to raise.

[Philip Davies]

I am very grateful to my hon. Friend for that. Let us hope—

[Mrs Moon]

Will the hon. Gentleman give way?

[Philip Davies]

As long as we are going to get on to a serious debate about the issue, I will give way to the hon. Lady. I know that she knows a lot about this issue, and if she wants to make a sensible point, I am very happy to give way to her.

[Mrs Moon]

I only ever make sensible points on the issue of suicide, on which I spend a considerable amount of my time.

I can tell the hon. Gentleman that for many families who have been blighted by suicide, the word “commit” is deeply offensive and causes great distress, because it is part of a feeling of alienation and criminality that enters their family. It is an issue of great sensitivity for them. I am sorry that the hon. Gentleman is rolling his eyes, but that is the reality.

[Philip Davies]

The hon. Lady has made her point. I would prefer that we actually dealt with trying to prevent people from taking their own life, or committing suicide, or whatever term anybody wants to use. The end result is the same and that is perhaps the thing we ought to concentrate on the most, rather than focus on what we call it, which does not necessarily help anybody who is a victim of it.

According to the Office for National Statistics, the number of female suicide victims declined from 10.9 per thousand in 1982 to 5.1 per thousand in 2013, whereas male suicide rates in the UK were much higher and were virtually the same in 2013 as they were in 1982—19 per thousand in 2013 and 20.6 per thousand in 1982. Those statistics sound bad enough, but it is nothing compared to the reality of suicide: according to the House of Commons Library, what that means is that in 2012, more than 4,500 men felt they had no choice but to take their own life. Given that there was an increase in suicides in 2013, the figure for that year is nearly 5,000 men.

In fact, over the last 30 years, according to ONS figures supplied by the House of Commons Library, more than 130,000 men have taken their own life. That is a staggering number: it is a staggering number of people who have needlessly died, and a staggering number of families left behind—parents, spouses, children, friends and colleagues —all of whom have been left grieving and suffering.

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[Mrs Madeleine Moon (Bridgend) (Lab)]

I am here to speak as the chair of the all-party group on suicide and self-harm prevention. I have spent a considerable amount of time examining the subject and raising its profile within Parliament.

Language does matter—being accurate about suicide and its legal status is incredibly important. If we continue to use the word “commit”, we continue to isolate families who have been bereaved by suicide and make those who take their own lives appear in a different class among those who have died. We continue to criminalise their actions, rather than examine what we can do and what responsibilities we can take to prevent further suicides.

I have talked to and worked with many families and individuals who have been bereaved by suicide, and all of them describe the same response—the isolation that they feel. Usually when a family suffers a bereavement, friends and neighbours are around them offering emotional and practical support. Someone with a family member who takes their own life is often isolated. People do not know what to say or do. Often the family are under police investigation because when there is such a death, the police’s first step is to look at whether that death is, in fact, a murder.

Many families have described to me the absolute shock of being investigated as though they were responsible for the death and may have murdered someone. People do not tend to cross police tape lines where the death has taken place, so they do not go to see the family. Often the police then leave because they have satisfied themselves that it is suicide, but they do not come back and explain to the family, “You are no longer under investigation, and by the way, this is where you might actually get some help and support.” One of the most important things that families need in those first few hours is to know, “What do I do? How do I deal with this?” They need to know how to respond to something that has left them shocked and asking, “Why? Why didn’t I notice? What could I have done to stop this? What did I miss?”

[Lucy Allan]

I thank the hon. Lady for her very important remarks. She is now three minutes into her speech and she has not mentioned International Men’s Day. Is she going to mention male suicide and International Men’s Day?

[Mrs Moon]

As I explained at the beginning of my speech, I am speaking on behalf of the all-party group on suicide and self-harm prevention. I will continue to do so.

We have to look at how we support families, including families of men who die by suicide—I concede that men are three times more likely to die by suicide than women. How do we support families and communities? For those who wish to understand how we can support those families, I recommend the excellent work of Sharon Macdonald at the University of Manchester.

We also have to look at what we are doing on suicide prevention planning in the UK. The all-party group looked at the Government’s suicide prevention plan prior to its implementation and then again following the reorganisation of health in the UK. The result was quite shocking, because the new prevention plan, which was very good in many respects and set out good guidelines, did not require local authorities and health authorities to report back to the Department of Health. We had no overall picture of what was happening across the country, so the all-party group went out and surveyed to find out what was going on.

We found that 30% of local authorities did no suicide audit work at all, so they did not know what was happening. They did not know how many men or women were taking their own life locally. Also, 30% of local authorities did not have a suicide prevention action plan; they were doing nothing to prevent the suicide of men or women across their local authority area. More worryingly, 40% of local authorities did not have a multi-agency suicide prevention group.

It is very important that we recognise that suicide is not the responsibility of one Department. It is not simply the responsibility of the Department of Health. In fact, the most active department in dealing with suicide is often the police. They are involved when people make unsuccessful early attempts. It is more likely that the police will know of someone who is about to take their life or who has been at risk in the past than any other agency.

Most suicides have never been anywhere near our mental health services, and it is important that we know what is happening locally. We need to ensure that local authorities’ multi-agency suicide prevention groups are made up of all agencies, including the local authority, the health agencies, the police and the third sector organisations that are often doing critical work on the ground—I cannot say enough about the fantastic support that we all receive every day from the Samaritans in our constituencies who spend their time tirelessly working with people who are very fragile and at high risk of suicide. Groups such as CALM, which the hon. Member for Shipley (Philip Davies) said has given him so much help ahead of today’s debate, are doing similar work. Those third sector organisations are made up of volunteers, many of whom have been affected by suicide and wish to move services forward so that further deaths can be averted.

It is vital that coroners engage with all their partners to prevent future deaths and to ensure that we are aware of where clusters may be beginning to develop, whether they are clusters within an age group, within an occupational group or within a school or factory. Social contagion is a big risk, and it is another example of why words matter. I have seen newspaper stories saying things such as, “Well, it’s just what we do around here.” If we give permission for suicide to be an acceptable way of dealing with the problems and difficulties of life, there is a risk of social contagion, with other people thinking, “That person was like me. If they can take their own life, I can, too.” That is a huge risk that we need to address. Social contagion is a great risk in closed institutions such as prisons, schools or factories, so we need to be aware of the importance of emotional education and language when people are faced with suicide.

I dread to say it, but the one point on which I agree with the hon. Gentleman is that the emotional education that we give to young men in this country is very poor. No matter how modern and how diverse a society we become, we still seem to educate our children to feel that they have to man up and be strong, and that they cannot talk about emotions. Some organisations, particularly sports organisations, have done fantastic work on suicide prevention.

I also stress the importance of longitudinal research on suicide and self-harm prevention. In the past I was fortunate to work with excellent Health Ministers, the former right hon. Member for Sutton and Cheam, Paul Burstow, and the right hon. Member for North Norfolk (Norman Lamb), who were both very supportive of suicide prevention work. If we are to have longitudinal studies of suicide and self-harm, the researchers dedicated to those subjects need to know that they will have the money to continue and pursue their work so that we have a clear idea of the numbers of deaths and whether those numbers are increasing or decreasing.

Other Members want to speak, so I will make a final comment. The all-party group on suicide and self-harm prevention, in association with the all-party group on mental health, will be having a meeting in February, which I hope the Minister will attend. A psychiatrist from my constituency will be coming up to talk about mental health triaging so that people at risk of mental health crisis can go to any agency, including their social worker or general practitioner, and receive help, advice and support through the triaging system, so that no one leaves being told that there is an appointment in six months’ time. We need to be on top of this. People are dying unnecessarily.

--- Later in debate ---

[Mr David Nuttall (Bury North) (Con)]

I start this afternoon by congratulating my hon. Friend the Member for Shipley (Philip Davies) on securing this historic debate. This is the first time ever that International Men’s Day has been marked by a debate in this Parliament. I also thank my right hon. Friend the Member for Basingstoke (Mrs Miller), as well as the hon. Members for Bridgend (Mrs Moon) and for York Central (Rachael Maskell), for bringing their individual perspectives to this debate.

Under the International Men’s Day heading, the debate gives us an opportunity to consider a range of issues that particularly affect men, but in my opinion none is more worrying than male suicide, so I will restrict my remarks today to that issue. The subject is all too often swept under the carpet. It was said at the outset of this debate that one of the problems facing us today is underachievement by white working-class boys from the north of England. Well, as a white working-class lad from the north of England, I am very proud to take part in this debate. Indeed, as a member of the Backbench Business Committee, I was pleased to play a very small part in granting this debate.

I listened with interest to the comments about why the debate is being held here in Westminster Hall rather than on the Floor of the House. However, as right hon. and hon. Members will be aware from the Order Paper, two debates have been scheduled for the Floor of the House this afternoon, one on the forthcoming Paris conference on climate change and the other on the new cancer strategy. It was felt that those debates needed to take place on the Floor of the House. Personally, I would have liked to see this debate take place on the Floor of the House as well, but we are where we are. It was also felt that we should try to hold this debate on International Men’s Day itself if at all possible, which is what we have achieved today.

As I say, I will try to restrict my remarks to the subject of male suicide. It is a subject that no one really wants to talk about.

[Mrs Moon]

To illustrate how important this debate is, let me tell the House that the first piece of evidence from professionals that the all-party group on suicide and self-harm prevention took was from a suicide prevention worker in London, who was also a mental health worker, and he said, “If I call a meeting to discuss mental health problems, I can fill a room. If I call a meeting to discuss suicide, I am there on my own.” That says everything. I thank everyone who is here today to take part in this debate for generating the conversation that is so vital.

[Mr Nuttall]

I am very grateful for that intervention, because that vignette highlights a lot of the problems. The mere fact that we are holding this debate—it may not be in the main Chamber, but it is here in Westminster Hall—and are able to discuss the subject will hopefully generate some wider debate outside Parliament. It might make it just that little bit easier for the debate to take place in wider society.

As I was saying, I approached the debate today with some trepidation, because, as has just been amply demonstrated by the hon. Lady, who is chair of the all-party group on suicide and self-harm prevention, many organisations and people seem to be looking at this problem—governmental bodies, other public sector bodies, charities in the independent sector and academics—and all have greater experience than I have, but I have looked at it with fresh eyes. Part of the reason why I am here today is that I am staggered by the intransigence of the problem. Clearly, there are many people looking at it, but the reality is that the number of male suicides has remained pretty stubborn over decades. This is not a party political point. It does not matter whether there was a Conservative Government under Mrs Thatcher or a Labour Government under Mr Blair; the numbers for male suicide have stayed pretty much the same. That made me think that there is something serious going on here that is wider than just the typical argument about party politics.

I pay tribute to the charity CALM—the Campaign Against Living Miserably—because it has provided some helpful briefing and figures for this afternoon’s debate. CALM says that in 2014 more than three quarters —76%—of suicides were men. That is 4,623 deaths. It is worth repeating that suicide is the biggest single killer of men under the age of 45. For deaths registered in 2013, the last year for which the Office for National Statistics has figures, my own region—the north-west of England, in which my constituency is situated—had a male suicide rate of 21.2. That is the second highest rate in the country, second only to the north-east. The experts will be aware that the rates are invariably quoted in the statistics as a rate per 100,000 of population, so that is 21 people out of every 100,000. As always with these statistics, there is a host of caveats and technical details that could be explored, but I do not think we should let the minutiae obscure the big picture, which is that while the suicide rate in the north-west among men was 21.2, the rate among females was 6.3. A rate of 21 against a rate of 6 is a big difference indeed.

[Mr Nuttall]

I have heard that statistic twice today, the first time in the Chamber, when the shadow Leader of the House made that point. I do not know whether the statistic is correct, but I am prepared to accept what the hon. Lady and the shadow Leader of the House say. I am sure that of those more than 4,000 deaths, some were gay men and some were young gay men. That may well be one of the contributing factors.

The charity CALM has set out four areas where it thinks action should be taken. First, and quite understandably, it states that there is a need for timely and accurate information. That could be applied to many things across Government. It always amazes me how long it takes for what, on the face of it, are fairly simply statistics to be collated and reach the public domain. Secondly, and again understandably, CALM says that we need to understand the reasons why people take their own life, because there is a strong element of contagion, which the hon. Member for Bridgend mentioned. Thirdly, CALM wants all local authorities to develop and implement a suicide prevention plan, and says that those that do not should be named. Fourthly, it states that if national and local suicide prevention plans are to be effective, there must be some accountability—there is no point having a plan unless something is done if that plan is not adhered to.

It is worth noting that in its own way, CALM has tried to give the issue some publicity through social media and the #BiggerIssues campaign, which is an advertising campaign to draw attention to the fact that as a society we tend to pay an inordinate amount of attention to perhaps relatively trivial topics, such as the weather and the sort of coffee we are drinking, rather than to male suicide, which is a real problem in society. The campaign has created digital posters featuring the hashtag #BiggerIssues, which were posted across the UK. Those posters changed every two hours to reflect the fact that every two hours, a man takes his own life. The campaign was run in association with the men’s grooming brand Lynx, and I think we should pay tribute to whoever it was who took that brave decision to link a men’s grooming product with the campaign. Others perhaps looked at it and thought, “The issue is a bit too touchy for us. We’ll leave that one alone.” Whoever was involved at Lynx, we should publicly thank them for being able to associate their brand with that particular campaign.

I was surprised to find that this phenomenon is not unique to this country. Right across the world and in almost every country, there is the same stark difference in the suicide rates. Lithuania, Russia, Japan, Hungary, Finland—almost everywhere we look, the picture is the same: male suicides considerably outnumber female suicides. Apparently that is not the case in China. I am not an academic; I have not spent time looking into this, but it seems to me there may be something in the fact that in one country, China, it is the other way around that may in years to come offer a solution to the problem.

We are a Parliament with different political parties, and for our own reasons we try to make party political points. When I have previously raised this issue, people immediately say, “Of course, it’s all the Government’s fault. The fact that there are lots of men committing suicide is all your Government’s fault, because you are making cuts to public services and you are cutting the NHS”—which is not true; more money is being spent on the NHS than ever before, so that argument immediately falls. Those arguments are easy to make. It is simple to throw out that it is all the Conservatives’ fault, but as I will demonstrate, the statistics—the facts—from the Office for National Statistics simply do not bear out that argument.

In the 1980s, under the Conservatives, the number of male suicides each year was somewhere between 4,000 and 5,000. It did vary a little bit—it got down as low as 4,066 in 1982 and it went up to 4,370 in 1987—but every year it was between 4,000 and 5,000. Between 1997 and 2010, under the Labour Government, the number of male suicides was somewhere between 4,000 and 5,000. Again, it varied—some years it was down, and some years it was up—but every year it was somewhere between 4,000 and 5,000. What is noticeable is that the gap between male and female suicide rates has been increasing steadily in almost every single year since 1981. At the start of this range of statistics, the male rate was a bit less than double the female rate—about 1.78 male suicides for every female suicide, I think.

[Mrs Moon]

Will the hon. Gentleman give way?

[Mr Nuttall]

I certainly will, but I will come back to my point, because I have not quite finished it.

[Mrs Moon]

This gets terribly technical. If I can explain, suicide is recorded under an international definition. To get the statistics, researchers are often required to go into coroners’ records and read individual narrative verdicts. The records therefore are slightly skewed; they are indicative, rather than totally accurate, because there is a difference between a clear suicide verdict that says that a death was a suicide and a narrative verdict that would need to mention intent. We have a problem with the accuracy of our recording. I thought it was important to clarify that.

[Mr Nuttall]

I am grateful for that. I think I mentioned that there is a host of caveats and technical details. I spent some time looking at the statistics and working out how they had been arrived at. As the hon. Lady rightly says, there are a number of difficult issues for researchers that could skew the figures, but whatever difficulties there might be, they apply equally to males and females and would not affect the overall point that I am making here which is that at the beginning of the 1980s, the difference was about double, and today it is about treble. It has gone from a ratio of about 2:1 to about 3:1 today. I do not think this change can simply be put down to Government policy. It was happening under a Conservative Government and continued to happen for 13 years under Labour Governments.

[Andrew Rosindell in the Chair]

Public Health England, which produces a raft of figures on this subject, states:

“Suicide often comes at the end point of a complex history of risk factors and distressing events.”

With other right hon. and hon. Members this afternoon, I pay tribute to the Samaritans, which is perhaps the best known charity in this field for its work in trying to help and to prevent men and women who are feeling depressed from taking their own life. In its review of 2012, the Samaritans found that men from working-class backgrounds were at a higher risk of suicide. The Samaritans stated that suicidal behaviour results from a complex interaction of numerous factors, including bereavement, divorce, unemployment and the historical culture of masculinity. It is a huge and complex subject. Many people will be grateful that we have highlighted some of the issues involved.

I hope that people who are feeling depressed—there are often many reasons and not just one—feel that they can tell someone about their worries. One thing we can all agree on, from whichever political viewpoint we approach the subject, is that suicide—taking one’s own life—is never the right answer. I hope the debate today will help break down the stigma that prevents many men from seeking the help they need.

A&E Services

Madeleine Moon Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

If the hon. Gentleman is seeking an apology, would he like to apologise for the fact that A&Es in England have missed their waiting time targets for the past 100 weeks? I do not see any trace of an apology or any scintilla of embarrassment on his face.

It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy. First, the declining access to social care and the squeeze on primary care have forced people to turn to A&E in increasing numbers and have also meant an increasing number of admissions that could have been avoided if people had received better care outside hospital. Secondly, the Government wasted £3 billion, at least, on a damaging top-down reorganisation that nobody wanted and nobody voted for, and which was hidden from the electorate. That reorganisation sucked resources from front-line patient care. We know that senior members of the Cabinet believe that the reorganisation was a catastrophic mistake. We know that, in the words of British Medical Association chair Mark Porter,

“the damage done to the NHS has been profound and intense”,

and we know that the reorganisation has not made the NHS more productive or more efficient.

Thirdly, the effect of that wastage has been compounded by the short-sighted cuts to nurse training places at the beginning of the previous Parliament. That means that there are not enough staff working in hospitals—that was a key criticism by the Keogh review. In addition to compromising patient safety and clinical outcomes, this Government’s decision has left trusts over-reliant on expensive agency staff.

[Mrs Madeleine Moon (Bridgend) (Lab)]

When I worked in hospitals and was responsible for arranging community-based discharge, two major problems created a delay in discharge—I hate the expression “bed-blocking” as it is such an insult to elderly people. One was access to community care facilities—home care support—and the other was ensuring that we had community equipment, such as hospital beds, hoists or bathing equipment. If we do not have all the pieces in place, which often come not from NHS funding but from local authority funding, it will not happen. That is exacerbating the problem in A&E.

[Mr Reed]

My hon. Friend makes a prescient point. The Government talk the talk but do not want the walk, and she has detailed precisely why that is the case.