Preventing Avoidable Sight Loss

Nusrat Ghani Excerpts

Tuesday 28th March 2017 Westminster Hall

[Nusrat Ghani (Wealden) (Con)]

I beg to move,

That this House has considered preventing avoidable sight loss.

I thank the Backbench Business Committee for allocating me this debate, the Chairman of Ways and Means for approving it and you, Mrs Gillan, for being in the Chair. I am also grateful to all the MPs who supported my application and to Lord Low of Dalston, my co-chair on the all-party parliamentary group on eye health and visual impairment, who, with his passion and experience of these issues, is a fantastic source of knowledge and support for the group. I believe that he is with us today in the Gallery.

The latest information from local authorities, which is from 2014, shows that almost 300,000 people in England and many thousands in Northern Ireland, Wales and Scotland are formally registered as blind or partially sighted. Many thousands more suffer from sight difficulties without being registered with their local authority. I thank the Royal National Institute of Blind People for its support as the secretariat of the all-party group, which I have the honour of chairing. The RNIB estimates that almost 2 million people in the UK live with sight loss. It is predicted that that will double to around 4 million by 2050 due to our ageing population and the fact that more people will live with conditions, such as diabetes, that can lead to visual impairment.

[Maggie Throup (Erewash) (Con)]

My hon. Friend talks about sight loss increasing in the future. Does she agree that obesity, which has the knock-on effect of causing type 2 diabetes, is one of the causes of sight loss? Children in their teens are being diagnosed with type 2 diabetes, so we really need to think about how we tackle and prevent that in the long term.

[Nusrat Ghani]

I definitely agree that we need to think about the long term and look at childhood obesity and diabetes, which are on the rise. I would like to put on the record that my application for this debate—I applied for a debate in the main Chamber—was supported by the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group on diabetes.

It is estimated that half of sight loss is potentially avoidable. Glaucoma is the single biggest cause of preventable sight loss. Some 600,000 people in the UK have glaucoma, but half are undiagnosed. If it is detected and treated early, around 90% of people with glaucoma retain useful eyesight for life.

[Mr Jim Cunningham (Coventry South) (Lab)]

Does the hon. Lady agree that one of the most important features of this situation is that at least half a million schoolchildren are affected, one way or another, by sight problems, if I may use that expression? Some 100,000 people in the west midlands, of which my constituency is a part, are probably also affected.

[Nusrat Ghani]

Of course. I will go on to mention children and the fact that it is necessary for them to be tested earlier than we previously believed they should be.

Wet age-related macular degeneration affects the retina and causes changes to central vision. In October last year, Jean Rugg’s eye clinic consultant told her that she needed follow-up treatment. She was told by the receptionist to expect the appointment in the post, but nothing arrived. By December, Jean was continually contacting the booking department and being turned away. She was told that she would not be booked in because the department was just too busy. Time passed. Jean noticed changes in her vision and was extremely worried about permanent damage to her sight. She was getting nowhere, so she contacted her consultant’s secretary and, after much urging, managed to secure an appointment with him to discuss her sight.

By that time, three months had passed. Jean’s consultant was alarmed that she had not received treatment sooner and explained that her vision could well have deteriorated due to the delay, as there had been further leakage of fluid into her eye. Jean needed an urgent course of injections, so the consultant took her to the booking department to try to secure an appointment that same week. They were both told that there were simply no spaces in the injection clinic. After repeatedly explaining the urgency of the matter, the consultant was eventually able to obtain an appointment for Jean the following week.

I am sure that the Minister agrees that that is just not good enough. That delay and lack of responsibility and urgency is just not acceptable. There are many more Jeans across the country. A 2014 survey by the Royal National Institute of Blind People showed that 86.5% of the public were more fearful of losing their sight than any other sense. As I said, 50% of all sight loss is potentially avoidable if treated early, yet NHS England does not give eye health the profile it deserves. There is no overarching NHS England-led strategy to govern it and push for more prevention of avoidable sight loss. There are equivalent strategies for hearing loss and dementia.

[Colleen Fletcher (Coventry North East) (Lab)]

The hon. Lady mentioned dementia, which is a growing problem, especially among elderly people, although not all elderly people. Sight loss can exacerbate or even mask symptoms for people with dementia. Correcting vision loss can help reduce the impact of dementia, at least in the early stages, and improve quality of life. Does she agree that policy makers and commissioners must seek to prioritise addressing sight loss for people who have dementia or are suffering its early onset?

[Nusrat Ghani]

I agree. We most definitely need to prioritise sight loss for all vulnerable people, including older people, who might also have mental health illnesses.

There are eye health strategies in place in Scotland, Wales and Northern Ireland; England is an anomaly. I therefore ask the Government to consider developing and implementing a national strategy for eye health in England. That would not require additional funding, but would be a commitment to improving the efficiency of eye care services and ensuring consistency across the country. It would enable the development of improved clinical leadership at clinical commissioning group level to prevent eye health from slipping down local commissioning agendas, enable closer partnerships between CCGs and local eye health networks, and aid commissioners to identify eye health priorities that respond to the needs of local populations.

The Department of Health and NHS England already do great work to support the voluntary sector-led England Vision strategy, but that is, by definition, limited in its ability to bring together all the relevant organisations in a joined-up way. In response to a written question that I tabled last week, the Department rightly explained that England’s size

“and the diversity of the health needs of different communities”

mean that commissioning is best “owned and managed locally”. I completely agree, but that should not be incompatible with strategic thinking from above by people who see the bigger picture, or establishing principles that local areas can fit to their circumstances.

Local commissioning must be coupled with national leadership. Leaving things to local commissioners is not working as well as it should. There is significant variation in the quality and quantity of services. For example, someone in Luton will wait for 15 days between their first attendance at a hospital out-patient clinic and their cataract surgery, but if they were in Swindon, they would wait not 15, 50 or even 150 days, but 180 days. That is a shocking difference. No doubt the Minister agrees that, again, that is just not good enough.

Small changes to guidelines and legislation would streamline the process for many patients. For example—my hon. Friend the Member for Twickenham (Dr Mathias) may have to help me out with my pronunciation—allowing orthoptists to sign hospital eye service spectacle prescriptions, rather than requiring ophthalmologists to sign them, would allow the delivery of effective patient care and reduce the number of appointments required to access spectacles.

[Mr Jim Cunningham]

rose—

[Nusrat Ghani]

I hope that the hon. Gentleman does not intend to make a quip about my pronunciation.

[Mr Cunningham]

The hon. Lady’s pronunciation is not as bad as mine. I would support a national strategy. More importantly, however, the cost of drugs for treatment is an area that creates difficulties. In 2014-15, the cost of two drugs alone to treat age-related macular degeneration was £287 million. There is room for discussion between the Government and the drug companies on the cost of drugs to treat people with eye problems.

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[Nusrat Ghani]

I thank the hon. Gentleman for his intervention. I hope that the Minister will respond to that and that we can tackle the postcode lottery in treatment and care across the country.

More generally, sustainability and transformation plans are an exciting opportunity to bring different parts of the NHS together, with greater efficiency and greater outcomes. They are designed to ensure that health and social care services in England are built around the needs of local populations. However, of the 44 STPs, only 22 mention ophthalmology. There is a gap in local plans, which could be narrowed by a national strategy. No doubt the Minister will share my disappointment that half of all STPs do not mention ophthalmology.

It is also worth noting that there are national strategies for other health conditions, in which local commissioners play a role alongside national leadership. The cancer strategy for England, for example, was developed by an independent cancer taskforce, including a number of charities. As a result, NHS England’s national cancer transformation board subsequently published an implementation plan. If there was a need for national leadership on cancer, dementia and strokes among other things, why does the same not apply to eye heath? If the Minister needs to look elsewhere for places where there are national eye health strategies, he could even look to Zimbabwe, which has one.

Professor Tim Briggs’s review of ophthalmology services in his capacity as national director for clinical quality and efficiency is warmly welcomed, but his review focused predominantly on secondary care. A national eye care strategy would cover all stages of the patient pathway, from prevention and early diagnosis to effective treatment and management, and high-quality rehabilitation and social care.

Early diagnosis is an important part of prevention, and it hinges on awareness. Eye health must be seen as a public health priority rather than in isolation from wider health and wellbeing issues. For example, too many people see eye tests simply as a way of identifying refractive error, but their purpose is wider: to identify eye conditions that could lead to loss or deterioration of sight at a later date and prevent that before it happens. Anyone entitled to a free eye test must know that they are entitled to it.

Vision defects in children include amblyopia, which can be mild but becomes more serious if left untreated or if the sight in the other eye is lost or damaged. In December 2013, the UK national screening committee recommended that screening should be offered to all children aged 4 to 5 years. However, children’s vision screening in schools has yet to be implemented across all local authorities. Some, where it does not exist, are not commissioning it, and some are decommissioning existing programmes. The national guidelines provide a population-based examination of all children, ensuring that at-risk and vulnerable children in the population are reached. How does the Minister see the future of eye treatment and screening for children, and how does that fit into wider healthcare plans? I know that NHS England is working with CCGs, general practitioners, patients and the public to improve patient choice in all secondary care services by 2020, not least to increase awareness and achieve improvements in patient outcomes and experience. That is extremely welcome, but will the Minister outline how that applies to ophthalmic services in particular?

When early diagnosis is achieved, referral processes must be equally efficient: straight to hospitals, rather than via GPs as happens in some areas, which is inefficient for patients, GPs and hospitals alike. I would be grateful if the Minister provided information on how optometrists and other service providers are encouraged to follow referral guidelines issued by the National Institute for Health and Care Excellence and professional bodies.

Preventing avoidable sight loss relies on timely access to treatment for eye conditions. The latest hospital episode statistics for ophthalmology show a picture of missed and delayed appointments across England. In the High Weald Lewes Havens CCG, which covers my constituency, 6.47% of ophthalmology appointments were cancelled by hospitals in 2015-16. In Sutton, that figure leapt to 26.17%. Cancelled appointments put people at risk of losing their sight unnecessarily, so I would welcome the Minister setting out how his Department works with hospitals and CCGs to ensure that such cancellations are as rare as possible.

As I draw to a close, I will briefly mention the UK’s work on global eye health. In May, the World Health Organisation will discuss how countries are delivering on the avoidable blindness plan. The UK is a signatory to that and also one of the largest supporters of aid to combat the neglected tropical diseases that often cause blindness. Some 90% of blindness is in the developing world, and 80% of cases can be cured or prevented. I pay tribute to the Sussex-based non-governmental organisation Sightsavers, which the Department for International Development supports to deliver British goals for the reduction of blindness abroad. I thank the Government for their international leadership on this important issue.

Back home, I pay tribute to all the work done by Lord Low, the co-chair of the all-party parliamentary group. I asked him what sight loss is like and what obstacles have to be overcome. He said that we cannot underestimate or understand the hurdles, time and energy it takes just to try to live independently and have access to services that the rest of us do to enable us to live a full life. There is also the importance of technology in this area, and how it must be harnessed to support people with sight loss.

Will the Minister explain how much work is being done to harness technology to help people with sight loss and how much work, commitment and finances are put into research? The eye research charity Fight for Sight has done so much commendable work in research. We cannot deal with some sight conditions, but the right amount of investment may help us tackle and stem the rise in sight loss in our ageing population.

Blindness and partial sight in the adult population costs the UK about £28 billion a year—not the £28 million mentioned in the House of Commons Library research paper. However, it costs so much more than that: opportunities are missed and careers stall. While disability employment in general is increasing, the one exception is eye disabilities. Family and relationships are challenged. I know the Government and the Minister are committed to reducing avoidable sight loss, improving the quality of life for people with sight loss and addressing persisting health inequalities. I finish by thanking the Minister for the work he does in this area and encouraging him to keep going.

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[Nusrat Ghani]

I have only a few minutes for my winding-up speech. It has taken a long time to discuss sight loss here in Parliament, but I am pleased that the Minister has responded so positively. Of course the all-party parliamentary group, the RNIB and I look forward to holding a meeting with him. We agree that the lack of local action, accountability and deliverables must be addressed. We are still convinced that it requires a national strategy, but we are more than happy to discuss that with him.

Fundamentally, the population is growing older, and more and more health problems are coming our way. The number of those with sight loss will increase from 2 million to 4 million. We need to do more on screening, research into treatments, prevention and ensuring that, regardless of where in England people live, they are treated equally and with dignity, within a period of time that ensures that preventable sight loss does not happen. Some 50% of current sight loss could have been prevented. That is not a statistic that we want to repeat.

Question put and agreed to.

Resolved,

That this House has considered preventing avoidable sight loss.

Young People’s Mental Health

Nusrat Ghani Excerpts

Thursday 27th October 2016 Commons Chamber

[Nusrat Ghani (Wealden) (Con)]

I would like to start by commending the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing such an important debate and raising so many important issues. The quality of the debate has been incredibly high so far, and I am grateful for the opportunity to be able to make a short contribution.

I will start, as others have, by paying tribute to the Youth Parliament. I want to give a shout-out to our young Members of the Youth Parliament in East Sussex: Joshua Moreton, Orla Phipps and Reuben Hayward-Brown. These MYPs do a fantastic job, and I hope that, one day, at least a couple of them will be sitting on these Benches as grown-up MPs—Madam Deputy Speaker, I am sure that you, for one, will agree that we could do with far more grown-up MPs in the House of Commons. The mentor of those three MYPs—and my mentor—Councillor Sylvia Tidy, has done a great job in supporting them, and she is a huge credit to East Sussex County Council.

I also pay tribute to the work of the Youth Select Committee, which has produced this important report. It is still shocking how mental health is treated as a second-class health issue, compared with physical illnesses.

This October, we recognise Breast Cancer Awareness Month by wearing pink ribbons. This month is also when some celebrate Halloween parties up and down the country. It remains a common occurrence for people to dress up as someone with a mental health illness because it is seen as scary to portray mental hospital patients next to flesh-eating zombies. In our culture, sufferers of mental illnesses are often supposed to be feared or ridiculed, and that must change. We have to challenge the stigma and attitude that are so present today; we must challenge those prejudices.

We are all often guilty of making assumptions that are just wrong—I am also guilty of that. As a new MP I received an early piece of casework. I heard about a young teenager who was struggling with an eating disorder, who was self-harming and who had run away from home. I just assumed it was a girl. When I met the parents, “she” was a boy.

We have already heard about the impact of mental health issues on young men. Suicide rates among young men are shockingly high. In the UK today, a young man between 20 and 49 is more likely to die as a result of suicide than he is to die from a cancer, in a road accident or from heart disease. The stats are shockingly high. We do better than Japan, where suicide is the leading cause of death for men aged 20 to 44, but we have a lot of work to do on prevention, early diagnosis and early treatment.

Mental illness also has consequences. It has particular consequences for young people who are already vulnerable to grooming and exploitation, who become more vulnerable when they suffer from a mental health issue. I recently chaired an inquiry for Barnardo’s into harmful sexual behaviour between children, where the victims and survivors are children, and where the perpetrators are children as well. A lack of self-esteem, an eating disorder or depression can sometimes be a factor in children committing, or being victims of, sexual abuse. That makes effective early diagnosis and therapy even more important.

There is an issue about these children sometimes being seen as troublesome, but not recognised as vulnerable or struggling with mental illness. Here, the Government can do more, by sharing best practice across schools, councils and police services. The integration of education and health is key—something my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) has already touched on.

The role of the digital world is also important in terms of its impact on young people’s mental health—something my hon. Friend the Member for High Peak (Andrew Bingham) has spoken about. The internet can be a dangerous vehicle for grooming vulnerable young people, so I especially welcome the Youth Select Committee’s recommendation that the Department of Health should develop a trusted app, with NHS branding, that young people can use to access mental health services—a positive use of the digital world that stands in stark contrast to the negative use of it. The Government have done great work on the youth mental health hub website, but the hub has not quite made it into app form, so I would be grateful for an update from the Minister.

Though we less youthful MPs have many disagreements across the Floor of the House, there is one thing on which we can all agree: we would be nowhere without the energy, enthusiasm and youthful brains of our hard-working teams. I was touched to hear the story of one young parliamentary assistant, who lost his brother to suicide. This is Jed’s story. Jed woke up on his day off to find his mum in despair at a Facebook message posted by his brother. The message read, “I’m sorry”, with the location, “At the Needles”—a beautiful but treacherous location on the Isle of Wight. Jed’s brother was hard-working, reliable, genuine and caring. He had suffered a marriage breakdown, but he was back to his former self, with a fantastic new girlfriend by his side. But Daniel Dwight took his own life. Writing afterwards, Jed said:

“It seems such a shame to think that he felt that he had nothing to live for...I for one can promise that I shall do everything I can to ensure that the world I grow old in will learn to be fairer, more caring, with a greater willingness to understand others whilst providing all important support.”

Jed’s experience, like that of others, shows what is at stake. We need to tackle stigma. We also need early diagnosis, early support and good-quality therapy that is offered within a sensible timeframe. Waiting months for therapy, whether for depression, anxiety, a personality disorder or an eating disorder, often just because someone has not quite reached a trigger level of concern, does not help them. It hinders their recovery because time allows their suffering to get worse, and they come to believe that their case cannot possibly be important, because if it was then surely the therapy would be provided sooner. This means that when the therapy finally is available, it is even less likely that it will be successful.

One of the key lines in the Youth Select Committee’s report is this:

“Until young people’s mental health services receive funding proportionate to that of physical health, we do not believe parity of esteem can be achieved.”

For me, that squares the circle. The amount of funding we put into mental health support and therapy is linked to our attitude towards it, and our attitude towards it is linked to the amount of funding we put into it. One must lead to the other. We in this place can lead on the funding, ensuring timely and good-quality therapy and support for mental health.

I welcome all the steps the Government have taken so far to improve support for mental health, and youth mental health in particular. The investment of an extra £1.4 billon in children and young people’s mental health services over the course of this Parliament is especially welcome, although there is always more that we could invest, and I urge the Minister to do exactly that. When funding parity is achieved, and timely and appropriate support is available to everyone who needs it, the taboo that surrounds mental health can be crushed.

Finally, I pay tribute to Jed for allowing me to share his touching account of the painful and still vivid memories of the day his brother committed suicide. We both hope that sharing his story might help to prevent others from taking that most desperate route, and remind any young person struggling with their mental health who is listening today that they are valuable and valued.

Community Pharmacy in 2016-17 and Beyond

Nusrat Ghani Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

I have never said that Leicester has too many pharmacies. What I said in answer to the urgent question was that one road in Leicester—Loughborough Road, I think—has 12 pharmacies within half a mile, and that is quite hard to justify.

As for the right hon. Gentleman’s other point about diabetes and long-term conditions, I mentioned the King’s Fund work being done by Richard Murray and addressing long-term conditions is the sort of value-added service that pharmacies need to provide in future. The £42 million integration fund that we have set aside will enable that to happen.

[Nusrat Ghani (Wealden) (Con)]

I welcome the news that this Conservative Government are spending £150 million more a year on pharmacies than the last Labour Government and will be paying pharmacies for not only dispensing prescriptions, but their quality of service. In Wealden, pharmacies have the double whammy of being rural and serving an older community, but they provide much-needed services and home deliveries. What news can the Minister share with me that I can share with pharmacies in Wealden?

[David Mowat]

The news that I can share is that pharmacies that are more than 1 mile apart from each other, many of which will exist in rural constituencies such as the hon. Lady’s, will be largely protected under the scheme.

Defending Public Services

Nusrat Ghani Excerpts

Monday 23rd May 2016 Commons Chamber

[Nigel Huddleston (Mid Worcestershire) (Con)]

It is a pleasure to follow the hon. Member for Scunthorpe (Nic Dakin), who as always represents his constituents with great passion.

I intend to focus on matters in the Queen’s Speech that relate to communications and the digital economy. In her Gracious Speech, Her Majesty spoke of legislation to be introduced to

“improve Britain’s competitiveness and make the United Kingdom a world leader in the digital economy”.

I wholeheartedly support that aim, and a great deal has already been achieved. Britain must be a nation where technology continuously transforms the economy, society and government. The UK has embraced digital transformation, and it is one of the most advanced digital economies on the planet. The internet as a UK industry sector has surpassed manufacturing and retail, and represents the second-biggest economic sector. That has come about as a result not just of the Government’s policies, but from the entrepreneurial efforts and passion of British businesspeople.

According to the Centre for Retail Research, UK consumers will spend an average of £1,372 per person online this year. Online retail as a percentage of total retail is 23% in the UK, which is more than double that of Germany and three times that of the US. A key driver of that is the underlying strength and sophistication of the UK’s financial services industry, and consumer confidence in the security of credit card and financial information online. That is not the case in many other countries, and lack of confidence in the security of online financial data has inhibited the development of the digital economy not only in the developing world, but across many countries in Europe. UK consumers’ online habits are so strong that, when asked what other lifestyle habit they would give up for a year instead of giving up the internet, 78% said they would rather give up chocolate; 21% said they would give up their car; alarmingly, 17% said they would give up showering; and most alarmingly of all, 25% said they would give up—I am not sure how to phrase this, Madam Deputy Speaker—intimate relations.

[Nusrat Ghani (Wealden) (Con)]

Can you elaborate on that or give an example?

[Nigel Huddleston]

Later on, perhaps, but I will spare my blushes now.

Digital is a UK success story. At 12.4% of GDP, the UK internet economy is the largest of the G20 countries—it is double the size of the US internet economy, three times that of Germany and nearly four times that of France. I have said this many times in the Chamber but it is often overlooked: the G20 average is 3.5% of GDP.

The digital economy employs more than 1.5 million people and is growing at more than double the rate of GDP growth. Clearly, we are already in a leading position in the world. The issue is not so much about becoming a world leader in the digital economy, but retaining and further strengthening our leadership position. Broadband plays a key role in that. We have made huge progress—superfast broadband of at least 24 megabits per second is available in 90% of homes and businesses in the UK, up from a mere 45% in 2010. Ofcom statistics show that business connections sometimes lag behind domestic connections, and companies such as BT Openreach need to do much more to get businesses connected and to improve customer service overall, particularly in remote and rural areas.

The broadband market remains confusing to many consumers and businesses. Research commissioned by Ofcom found that around half of small and medium-sized enterprises found that information about suppliers and tariffs was difficult to compare. I am therefore pleased that the Government are making progress to improve competition, particularly by making the switching process clearer and easier in both the broadband and mobile markets.

On the specific digital measures announced in the Queen’s Speech, I very much welcome the digital economy Bill, which will deliver on the manifesto commitment to roll out universal broadband and increase competition. The new electronic communication code will make it easier and cheaper to build mobile and superfast broadband infrastructure. We must protect and support our digital industries, which is why the introduction of equal penalties for infringements of online and physical copyright is so important. I warmly welcome the proposals to protect children with age verification for accessing online pornography.

The BBC has played a key role in shaping how we are educated, entertained and informed in the UK, via radio, TV, print and online. The BBC iPlayer is one of the most-used digital content sites in the UK. According to last year’s annual report, in January 2015 alone, 264 million iPlayer requests were made. Similarly, more than 27 million unique users in the UK went to BBC News online each week in the first three months of 2015. Those numbers will be higher now.

The BBC has clearly played and will continue to play a key role in the future of the UK digital economy. I therefore welcome the proposals in the recent White Paper to secure the BBC’s future. Many people have been in contact with me about the future of the BBC, expressing suggestions and concerns. I am glad that many of those fears were allayed in the White Paper. Contrary to the predictions of some, there was no wholesale destruction of the BBC, no abolition of the licence fee, no meddling with TV schedules and no instruction not to make popular programmes. Instead, there will be a longer charter, clarity on funding, improved governance, and opportunities for more commercial exploitation of the BBC’s hugely valuable content library. The simple fact of the matter is that the BBC will be in a stronger not weaker position as a result of the recommendations in the White Paper.

There is much to be praised in the Queen’s speech, and I am confident that the focus on the digital economy and technology will have long-lasting consequences that will benefit the UK economy for decades to come.

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[Nusrat Ghani (Wealden) (Con)]

It is a great pleasure to follow the hon. Member for North Ayrshire and Arran (Patricia Gibson).

I want to talk about protecting and supporting vulnerable people, particularly children and young adults, which is a theme that emerges strongly from the Government’s legislative programme, and focus on life chances. On 31 March 2015, there were 69,540 looked-after children, and according to Adoption UK, as many as 61% of them were looked after by the state because of abuse or neglect. Only 5,330 looked-after children were adopted during the year ending last March, which was a welcome improvement, proportionately, on previous years but still far too few.

I therefore welcome the ambition in the Children and Social Work Bill to provide more children with stable and loving homes through long-term adoption. Stability, security and permanent affection are central to enhancing life chances, and the new commitment to extend the right of care leavers to a personal adviser up to the age of 25 is central to that mission, and I warmly welcome it. The assumption that a young person will be ready to face the world at the age of 18 became old fashioned long ago and was never really the case for people in the care system.

When it comes to looking after the nation’s young people, an increasingly important issue is harmful sexual behaviour. Child abuse gets a lot of coverage but harmful behaviour between children does not. I am currently chairing an inquiry with Barnardo’s into support and sanctions for children who display and are victims of harmful sexual behaviour. We have heard harrowing testimonies from young people with experiences ranging from the use of sexual language inappropriate for a particular age to the sharing of explicit images, online grooming and sexual acts themselves. The risk is increased for children in care.

This issue is rarely tackled because it is tough and uncomfortable to do so, but it is important that both perpetrators and victims have the chance for their experiences to be heard and that we in Parliament act. One young person was looked after from the age of 12. She had an abusive family background and parents with mental health difficulties and was a victim of child sexual exploitation while being looked after in a local children’s unit. She was described as naive, keen for affection and vulnerable to coercion and was exploited by men whom she believed to be her boyfriends.

In such circumstances, we must make sure that the duty of care, which should be shared by everyone—parents, foster parents, carers, teachers, social workers, medical practitioners and police forces—is indeed shared and that there are no gaps or loopholes. I hope that Ministers will take issues such as harmful sexual behaviour into account when considering the precise measures in the Bill, particularly around foster care, the role of schools, police training and standards for social work. I will be highlighting our inquiry’s recommendations to the Government when they are announced within the next few months.

I turn now to the counter-extremism and safeguarding Bill. As a member of the Home Affairs Committee, I take a particular interest in this area, but I am sure that Ministers recognise that tackling extremism is not just a home affairs issue. It is a challenge for our justice system; within education, it is a duty-of-care issue; it is a foreign policy and defence concern; it is an equalities matter; it involves social media; and, above all, it is a life chances issue. It cannot be tackled in isolation as just a home affairs issue, because the causes, the consequences and the challenges are global and multi-dimensional. I know that Ministers will closely consider how Departments across Government can be brought together to make the Bill as effective as possible.

Members of the Muslim community are fighting for the survival of their families and communities, seeking to challenge divisive and hateful views, and deserve our support and encouragement as they challenge those ideologies on their own doorsteps. These ideologies and this extremism, increasingly rife, are like an invasive species. The Islam that came to this country with the communities that have settled here since the second world war is not the Islam now taught in some Muslim schools or practised in certain mosques. Wahhabi Islam is not the faith of my parents and does not reflect the cultural richness of the Muslim communities of the subcontinent, from which most of our diaspora come. Rather like an invasive species, Wahhabism has driven out many of the traditions that make my faith a spiritual rather than a political journey. It represents teachings that interpret Islam as a narrow stone age rulebook intolerant of modern society’s norms or indeed much of the basic human decency that we take for granted.

The fight against extremism is not one that should be fought just from Westminster using Westminster’s tools. As the Prime Minister noted in a reply to me last Wednesday, we must empower Muslims to challenge intolerant and hateful ideologies. It takes a huge amount of courage to speak out against organisations when there are self-appointed leaders who groom the young and impressionable. To tackle extremism and to protect vulnerable young people from being attracted to it, we have to challenge it both at source and later on in its journey. We need to think about the establishments, groups and forums where some of these divisive ideas are coming from. I hope the Bill will look at how we can prevent religious or educational establishments from receiving overseas funding if they are unwilling to sign up to an agreed set of tolerant principles that their own society considers acceptable. We already have rules that funders of political parties and unions must adhere to, so why not have them for these other institutions, too?

Safeguarding children from extremism requires powers to take action in any education setting where vulnerable children may be at risk of grooming and indoctrination. Grooming a child for sexual exploitation was once misunderstood; now it is rightly a cause for extreme action and punishment. The same should be the case for educators and youth leaders who teach hate, including those at the centre of events in Birmingham’s “Trojan horse” schools. We should never allow those individuals back into the classroom or to have any leadership role with children.

On integration and life chances, I have been very encouraged by my conversations with Louise Casey about her review of relations within and between communities, and I am sure that the Government will look to incorporate some of her central recommendations into this and other legislation.

Modern challenges in modern times need modern and bold legislation. Being cautious is not the job of a responsible Government who are effective at taking on those challenges. So I warmly welcome the proposals set out in this Queen’s Speech, and the values and aims that thread through them. When each of these proposals is taken forward, I urge the Government to stay the course and to continue to be ambitious in tackling the challenges they have rightly prioritised as needing our attention and focus.

Oral Answers to Questions

Nusrat Ghani Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ben Gummer]

Despite the best efforts of Labour Members, staff morale has gone up over the past few years. The situation is not helped when the nature of the junior doctors contract is misrepresented, as it continually is by Labour Members. If they were to give a fair account of the contract to their constituents, I am sure we would see further improvements in staff morale in years to come.

[Nusrat Ghani (Wealden) (Con)]

Staff morale at Uckfield community hospital is exceptionally high, partly owing to its receiving 100% in a recent friends and family survey. Will the Minister join me in congratulating all the nurses, volunteers and front-office staff in Uckfield community hospital?

[Ben Gummer]

I happily congratulate the staff at my hon. Friend’s local hospital. This shows where good constituency representation, reinforcing the efforts of local people working in local hospitals, can produce improvements in staff morale and therefore in the experience of patients, which is something from which Labour Members would do well to learn.

Oral Answers to Questions

Nusrat Ghani Excerpts

Tuesday 9th February 2016 Commons Chamber

[Jane Ellison]

We made considerable progress in this area in the last Parliament, under the responsibility deal, but we have always said that there is more to do and the challenge to industry remains. We will say more about that when we publish the childhood obesity strategy in due course.

[Nusrat Ghani (Wealden) (Con)]

Midwife-led units, such as the brilliant Crowborough birthing centre in my constituency of Wealden, are key to the provision of high-quality, safe and compassionate maternity care. Last year, it scored 100% satisfaction on a friends and family survey. Will my hon. Friend outline the Government’s plans for midwife-led care, particularly given this weekend’s launch by The Sunday Times of the safer births campaign?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Midwife-led units have increased in number in the past few years, to the great advantage of women wanting a full range of choice when they give birth. That is why we are all looking forward to the publication of the Cumberlege review, which I hope will map out the future of maternity services and show what midwife-led units will do within maternity services in the NHS. I am very excited about that, and I know that my hon. Friend will be, too.

Dementia Care Services

Nusrat Ghani Excerpts

Wednesday 9th September 2015 Westminster Hall

[Nusrat Ghani (Wealden) (Con)]

Thank you, Mr Davies, for the opportunity to contribute to this important debate. I congratulate my hon. Friend the Member for Charnwood (Edward Argar) on securing it. He raised many issues that I was going to speak on, so I will keep my speech short. I must declare that I am the chair of the all-party group on ageing and older people, and I previously worked for Age UK. Dementia is an issue particularly close to my heart, and I am delighted that we have the chance to discuss it today.

On 12 September, All Saints church in Crowborough in my constituency is hosting a day conference entitled “Living with Dementia”. Hilary Mackelden, a constituent of mine, once feared that she had dementia, and wrote about the condition in my local paper, the Kent and Sussex Courier:

“There can be no more terrifying illness. How do you cope in a world you don’t recognise, with people who say they love you but who you think are strangers?...How should that world respond to and support you?”

In our ageing society, ever greater pressure is being put on healthcare services and charities, so our response to dementia is a vital humanitarian and social care issue. In my region of east Sussex, one in four of the population is aged 65 and over. It is predicted that one in three people aged 65 and over will develop dementia, which means that as many as one resident in every 12 could suffer from the condition. What is more, it is estimated that there will be an 11.3% increase in the number of people aged 85 and over in east Sussex by 2019. That means not only that more people will develop the condition as they grow older, but that those who develop it at an early age will require care and support for a longer period as their life expectancy increases, which will inevitably put huge pressure on care providers.

In Wealden, under the leadership of Councillor Bill Bentley, we are already tackling our responsibility for managing the multiple healthcare and social care needs of our elderly. There are concerns that budget restraints will affect the delivery of community-led programmes for dementia sufferers and respite for their carers.

Dementia-friendly communities do much to promote the rights, welfare, independence and livelihoods of people with dementia, and they help to eliminate the stigma that surrounds it. My right hon. Friend the Prime Minister championed them as part of the Prime Minister’s challenge on dementia. I am proud to represent Rotherfield, a dementia-friendly village. We do not yet have a dementia-friendly town, but I will go home with that ambition. The church of Rotherfield St Martin is a charity that works to ensure that elderly people are supported to live their lives the way they want to. It is run by Jo and Sasha Evans, who should be commended for their work. I was delighted that Rotherfield St Martin was nominated for a “Small Charity, Big Achiever” award at the Third Sector Awards last month. I wish them every success when the winner is announced in a couple of weeks.

We should not underestimate the work of local councils, which support people with dementia by helping to create dementia-friendly communities. The upcoming spending review is an important part of the Government’s entirely necessary effort to eliminate the deficit, but I hope it will not compromise local councils’ ability to support dementia-friendly communities. What action is the Minister’s Department taking to ensure that future funding settlements take account of our ageing population? What pressure does she anticipate that local authorities—particularly those in the south-east—will face in the coming years? Projections tell us that we are likely to have to reduce significantly support for people with dementia and their carers. I urge the Minister to ensure that does not happen.

By 2021, there will be more than 1 million people living with dementia in the UK. One in three people over 65 will die with dementia, and dementia costs the UK £23 billion a year, not to mention the incalculable costs to individuals and families, who give so much time, energy and love to offer care. NHS England has been set a target of diagnosing 66%, and my hon. Friend the Member for Charnwood mentioned reaching a target of 75%. Has that target been met, and will we continue to be ambitious by setting even higher targets?

At the heart of the issue is the fact that dementia takes so much away from people: their ability to recognise loved ones, remember special occasions and communicate as they once could. It would be cruelly ironic were we to allow some of the support that dementia sufferers and their carers depend on to be taken away. We owe it to dementia sufferers and their carers to fight for the support they count on and the funding it requires. I hope this debate will throw that obligation into sharp relief.