There have been 91 exchanges involving Andrew Selous and the Department of Health and Social Care
|Tue 10th November 2020||Obesity: Covid-19 (Westminster Hall)||7 interactions (1,403 words)|
|Mon 19th October 2020||Covid-19 Update||3 interactions (62 words)|
|Mon 5th October 2020||Covid-19 Update||3 interactions (53 words)|
|Thu 17th September 2020||Covid-19 Update||3 interactions (73 words)|
|Tue 15th September 2020||Coronavirus||3 interactions (50 words)|
|Mon 20th July 2020||Coronavirus Response||3 interactions (56 words)|
|Wed 23rd October 2019||The National Health Service||5 interactions (880 words)|
|Tue 23rd July 2019||Oral Answers to Questions||3 interactions (58 words)|
|Tue 18th June 2019||Oral Answers to Questions||3 interactions (76 words)|
|Thu 16th May 2019||National Marriage and Mental Health Awareness Weeks (Westminster Hall)||3 interactions (2,171 words)|
|Tue 26th March 2019||Oral Answers to Questions||3 interactions (54 words)|
|Thu 21st March 2019||Services for People with Autism||3 interactions (121 words)|
|Wed 27th February 2019||Dental Health: Older People||8 interactions (2,343 words)|
|Wed 30th January 2019||Early Parenthood: Supporting Fathers (Westminster Hall)||7 interactions (819 words)|
|Tue 15th January 2019||Oral Answers to Questions||5 interactions (55 words)|
|Wed 9th January 2019||Diabetes (Westminster Hall)||12 interactions (1,353 words)|
|Tue 27th November 2018||Oral Answers to Questions||3 interactions (39 words)|
|Mon 5th November 2018||Prevention of Ill Health: Government Vision||3 interactions (42 words)|
|Tue 23rd October 2018||Oral Answers to Questions||3 interactions (70 words)|
|Wed 17th October 2018||Social Care Funding||3 interactions (62 words)|
|Thu 6th September 2018||Integrated Care (Westminster Hall)||5 interactions (1,304 words)|
|Thu 19th July 2018||Perinatal Mental Illness (Westminster Hall)||12 interactions (1,841 words)|
|Thu 28th June 2018||Adult Social Care: Long-term Funding||3 interactions (140 words)|
|Mon 25th June 2018||Childhood Obesity Strategy: Chapter 2||3 interactions (54 words)|
|Thu 21st June 2018||ME: Treatment and Research (Westminster Hall)||7 interactions (127 words)|
|Wed 20th June 2018||Gosport Independent Panel: Publication of Report||3 interactions (86 words)|
|Tue 8th May 2018||Oral Answers to Questions||3 interactions (71 words)|
|Wed 25th April 2018||Social Care||9 interactions (663 words)|
|Mon 23rd April 2018||Privatisation of NHS Services (Westminster Hall)||15 interactions (1,047 words)|
|Wed 18th April 2018||Austerity: Life Expectancy (Westminster Hall)||9 interactions (721 words)|
|Wed 21st February 2018||Medicines and Medical Devices Safety Review||3 interactions (67 words)|
|Tue 6th February 2018||Oral Answers to Questions||3 interactions (40 words)|
|Mon 5th February 2018||NHS Winter Crisis||3 interactions (63 words)|
|Tue 16th January 2018||Junk Food Advertising and Childhood Obesity (Westminster Hall)||11 interactions (1,364 words)|
|Wed 10th January 2018||NHS Winter Crisis||3 interactions (584 words)|
|Mon 8th January 2018||NHS Winter Crisis||3 interactions (49 words)|
|Tue 19th December 2017||Oral Answers to Questions||3 interactions (61 words)|
|Tue 28th November 2017||Maternity Safety Strategy||3 interactions (51 words)|
|Tue 14th November 2017||Oral Answers to Questions||3 interactions (40 words)|
|Tue 31st October 2017||Children’s Oral Health (Westminster Hall)||7 interactions (837 words)|
|Wed 25th October 2017||Social Care||3 interactions (826 words)|
|Wed 13th September 2017||NHS Pay||5 interactions (817 words)|
|Tue 4th July 2017||Oral Answers to Questions||3 interactions (43 words)|
|Tue 21st March 2017||Oral Answers to Questions||3 interactions (78 words)|
|Mon 6th March 2017||Young-onset Parkinson’s Disease||3 interactions (76 words)|
|Mon 27th February 2017||Health and Social Care||5 interactions (1,395 words)|
|Tue 7th February 2017||Oral Answers to Questions||3 interactions (48 words)|
|Mon 30th January 2017||Agenda for Change: NHS Pay Restraint (Westminster Hall)||3 interactions (61 words)|
|Thu 19th January 2017||NHS Fertility Services (Westminster Hall)||3 interactions (53 words)|
|Wed 11th January 2017||NHS and Social Care Funding||9 interactions (1,169 words)|
|Mon 9th January 2017||Mental Health and NHS Performance||3 interactions (41 words)|
|Tue 20th December 2016||Oral Answers to Questions||3 interactions (66 words)|
|Tue 13th December 2016||CQC: NHS Deaths Review||3 interactions (48 words)|
|Mon 12th December 2016||Social Care Funding||3 interactions (64 words)|
|Tue 22nd November 2016||National Health Service Funding||7 interactions (597 words)|
|Tue 15th November 2016||Oral Answers to Questions||3 interactions (66 words)|
|Tue 15th November 2016||Health Service Medical Supplies (Costs) Bill (Second sitting) (Public Bill Committees)||2 interactions (39 words)|
|Thu 3rd November 2016||A&E Departments: Winter Pressure||3 interactions (88 words)|
|Mon 31st October 2016||NHS Funding||3 interactions (42 words)|
|Mon 24th October 2016||Health Service Medical Supplies (Costs) Bill||5 interactions (1,131 words)|
|Tue 15th July 2014||Oral Answers to Questions||7 interactions (110 words)|
|Tue 24th June 2014||Patient Safety||3 interactions (40 words)|
|Thu 1st May 2014||Care Homes||3 interactions (62 words)|
|Wed 9th April 2014||Abortion (Disability)||3 interactions (46 words)|
|Tue 1st April 2014||Oral Answers to Questions||4 interactions (58 words)|
|Wed 5th March 2014||Adult Autism Strategy (Westminster Hall)||3 interactions (91 words)|
|Thu 13th February 2014||Cancer Priorities||3 interactions (1,395 words)|
|Mon 10th February 2014||Children and Families Bill||3 interactions (262 words)|
|Tue 26th November 2013||Oral Answers to Questions||5 interactions (77 words)|
|Thu 7th November 2013||Group B Streptococcus (Newborn Babies)||7 interactions (161 words)|
|Wed 16th October 2013||Psychological Therapies (Westminster Hall)||11 interactions (1,914 words)|
|Tue 10th September 2013||Accident and Emergency Departments||3 interactions (72 words)|
|Tue 3rd September 2013||Brain Tumours in Children (Westminster Hall)||9 interactions (85 words)|
|Wed 17th July 2013||Managing Risk in the NHS||3 interactions (68 words)|
|Fri 12th July 2013||Tobacco Packaging||3 interactions (100 words)|
|Wed 5th June 2013||Accident and Emergency Waiting Times||3 interactions (60 words)|
|Mon 25th March 2013||Immigrants (NHS Treatment)||3 interactions (56 words)|
|Thu 14th March 2013||Accountability and Transparency in the NHS||3 interactions (770 words)|
|Wed 12th December 2012||NHS Funding||3 interactions (56 words)|
|Mon 10th December 2012||Winterbourne View||3 interactions (61 words)|
|Tue 17th July 2012||Oral Answers to Questions||6 interactions (85 words)|
|Tue 17th July 2012||Health||3 interactions (758 words)|
|Tue 12th June 2012||Oral Answers to Questions||5 interactions (74 words)|
|Tue 13th March 2012||Health and Social Care Bill||13 interactions (1,021 words)|
|Tue 28th February 2012||Health and Social Care Bill||3 interactions (32 words)|
|Tue 17th January 2012||Care of the Dying (Westminster Hall)||3 interactions (42 words)|
|Mon 12th December 2011||Pregnancy Counselling||3 interactions (95 words)|
|Wed 7th September 2011||Health and Social Care (Re-committed) Bill||11 interactions (201 words)|
|Tue 25th January 2011||Oral Answers to Questions||5 interactions (108 words)|
|Tue 2nd November 2010||Termination of Pregnancy (Information Provided)||3 interactions (27 words)|
|Tue 7th September 2010||Oral Answers to Questions||3 interactions (44 words)|
I beg to move,
That this House has considered obesity and the covid-19 outbreak.
This issue has come to my attention so many times over the past few months—I am highly aware of it. I applied for this debate in March, but because of the covid-19 restrictions I was able only to introduce a petition. I am glad to have reached this pinnacle of opportunity to speak on the matter.
I thank colleagues who supported my application for the debate and the Backbench Business Committee, which kindly found time for us to discuss this important issue. I also thank Members for attending the debate and for emailing me to register their interest in speaking in it. I look forward to hearing from the shadow spokespersons of the SNP and Labour party, and especially from our Minister, who is always courteous to everyone, with the answers we hope to hear from her on this topic of great importance.
For the first time in many a month this nation can smile, following the news this morning that it is hoped a vaccine will be available. I do not want to pre-empt the final trials, but for once the nation smiles with hope that better days lie ahead, which must good news for us all.
Obesity is one of the country’s greatest health challenges. The UK has, unfortunately, the highest obesity rates in western Europe, and they are rising faster than those of any other developed nation. We cannot ignore that, which is why we are debating it today and why the Minister is here to respond. We are a majority-overweight nation, with more than six in 10 UK adults being overweight or living with obesity. That has a significant effect on the nation’s health, on the NHS and on the quality of life of each and every one of us living with the condition.
Obesity increases the risk of developing conditions such as type 2 diabetes, and I declare an interest as a type 2 diabetic. I was once a 17 stone, overweight person.
I was having Chinese takeaway five nights a week with two bottles of Coke. It was not the way to live life, but I had a very sweet tooth.
Until about a year before I realised I was a diabetic I did not know the symptoms. My vision was a wee bit blurred and I was drinking lots of liquids—two signs that should tell you right away that something is not right. I took a drastic decision to reduce weight and lost some 4 stone, which I have managed to keep off.
We need to look at our diet and our lifestyle. We all live under stress, and we all need a bit of stress because it keeps us sharp, but there is a point where we draw the line. I recall the day I went to the doctor and he told me, “We are going to put you on a wee blood pressure tablet.” I said: “If that is what you think, doctor, I will do what you say.” He added: “When you start it, you have to keep at it. You cannot take a blood pressure tablet today and then not take it next week, because your system will go askew.”
Obesity leads to high blood pressure and some types of cancer and is strongly associated with mental health and wellbeing, which is so important in the current crisis. There are strong links between the prevalence of obesity and social and economic deprivation. People living with obesity face extraordinary levels of stigma and abuse. We need to be careful and to be cognisant of other people’s circumstances, because they might have a genetic imbalance, which I will speak about later.
The outbreak of covid-19 makes the obesity epidemic more urgent. It is deeply concerning that obesity is a risk factor for hospitalisation, admission to intensive care and death from covid-19. The facts are real. People with a body mass index of 35 to 40 are 40% more likely to die from covid-19 than those of a healthy weight. In people with a BMI of 40-plus, it rises to 90%. That places the UK population in a very vulnerable position.
In the latest report from the Intensive Care National Audit and Research Centre, which audits intensive care units in England, Wales and Northern Ireland, almost half—47%—of patients in critical care with covid-19 since 1 September had a BMI of 30 or more. In other words, they were classified as obese. Those figures show that almost half the people in critical care had a lifestyle that they needed to address. That figure compares with the 29% of the adult population in England who have a BMI of 30 or more. People with obesity are much more likely to be admitted to critical care with coronavirus.
We also know that covid-19 has a greater impact among black, Asian and minority ethnic communities. Currently, 74% of black adults are either overweight or living with obesity. That is the highest percentage of all ethnic groups. That is a fact—an observation—not a statement against any group, but we have to look to where the problems are and see how we can reach out to help, because we need to reach those groups.
It is encouraging to see the Government setting out the steps that they will take to support people to live healthier lives and reduce obesity. Those steps will make a positive contribution to the environment we live in and will encourage people to make healthier choices, helping to prevent obesity. I will also speak about other groups, because it is sometimes those in a certain financial group who do not have the ability to buy the correct foods and are driven by the moneys that they have available.
The Government now have to implement their proposals and fund them adequately. Then they need to measure their success and to review what more can be done. Three childhood obesity strategies have been published since 2016, and the proposals have not yet been fully implemented. One reason we are here today is to see how those proposals can be implemented, and we need a timescale. I know we are on the cusp of finding a vaccine, but we also need to address the issue of obesity in the nation as a whole. Perhaps covid-19 is an opportunity to address it. We cannot afford a delay. It has to be an urgent priority for the Government and the Minister if we are to protect people from severe illness from covid-19.
Furthermore, we need to address the structural drivers of obesity. Inequality is a key element, as I mentioned a little earlier. Obesity prevalence in children is strongly linked to socioeconomic deprivation. Families with lower incomes are more likely to buy cheaper and unhealthier food because what drives them—let us be honest—is what is on offer this week and what budget is available to buy the food that is on the shelf. We do not always check the labels. Is it high in calories, sugar and salt? Those are things that we probably should check, but we do not, because the driver is money.
A report by the Food Foundation in 2018 found that the poorest 10% of households need to spend 74% of their income on food to meet its Eatwell guide costs. That is impossible for people on low incomes. When the Minister sums up, perhaps she will give us her thoughts on how we can address that issue directly.
I welcome the Prime Minister’s commitment to the support for schoolchildren and school meals. It is good news; it is good to know that the four nations in this great United Kingdom of Great Britain and Northern Ireland are united in taking action on that issue. Scotland is doing it, Northern Ireland is doing it, Wales is doing it and now England is doing it. That is good news, because by reaching out and offering those school meals we will help to address some of the issues of deprivation and how the mums and dads spend the money for food in the shop. This is a way of doing that. We all know that school meals have a balance as well, so it is really important over the coming school breaks and other times that children have the opportunity to have them. In Northern Ireland, the Education Minister set aside £1.3 million to help to provide school meals over the coming period.
The Government need to work more closely with the food and drink industry as well, to make the healthy option the easiest option. However, while we need to support healthier choices and behaviours, there is no point in seeking to make individuals’ behaviours healthier if the environment in which they live is not suited to healthy behaviour. It is okay to say these things, but how do we make them happen? We need to look further at the social factors that lead to obesity, and we need to address them to make them more conducive to healthy living. To give just two examples, eating more fruit and vegetables and walking, which gives the opportunity to be out and about, are among the things that we need to look at.
There is a long-term process, which involves planning, housing, the workplace, the food supply, communities and even the culture of life in the places that we live in. It is about the groups of people we live with and the people we have everyday contact with. Earlier, I mentioned genetics, which is also an important factor in causing obesity. Again, it is a fact of life that there are people who may carry extra weight because of their genetics. Indeed, it is suggested that between 40% and 70% of variance in body weight is due to genetic factors, with many different genes contributing to obesity. Again, I am sure the Government have done some research on that issue, working with the bodies that would have an interest and even an involvement in it. It might be helpful to hear how those people who have a genetic imbalance, for want of a better description, can address it.
Without going into the motivations and challenges faced by people living with obesity, and particularly those living with severe obesity, it is clear that it is not always easy for them to lose weight. Let us be honest: it is not easy to lose weight. Some people say, “Well, what do you do? Do you stop eating? Do you cut back on your eating?” But if someone enjoys their food—I enjoy my food, although in smaller quantities, I have to say—and overeats, we have to address that issue as well.
We want to encourage people to improve their wellbeing and mental health and to have the willpower. There are a lot of factors that need to be part of that process. I was therefore pleased that the Government strategy sets out plans to work with the NHS to expand weight management services. Again, perhaps the Minister will give us some idea of what those services will be.
Support for people to manage their weight can range from diet and exercise advice to specialist multidisciplinary support, including on psychological and mental health aspects, and bariatric surgery. We have the National Institute for Health and Care Excellence guidance on these treatment options, which sets out who should be eligible for them, yet they are not universally commissioned, which means that many patients cannot access support even if they want to. Given the urgent need for people to reduce weight to protect themselves against covid-19, we need to make these services more accessible by increasing their availability and the information provided about them to patients and the public.
Over the years, I have had occasion to help constituents who probably had a genetic imbalance and were severely overweight. The only way forward for those people—men and women—was to have bariatric surgery. On every occasion that I am aware of involving one of my constituents, bariatric surgery was successful. It helped them to achieve the weight loss that they needed and it reduced their appetite. That made sure that their future was going to be a healthy one.
We have strict acceptance criteria in the NHS for obesity treatment that are not found with other conditions. If a person has a BMI of 50, they must follow diet and exercise advice and receive a multidisciplinary specialist report. These services are otherwise known as tier 2 and tier 3 services. We are almost sick of hearing of tiers 1, 2 and 3, but they are a fact of life for obese people before they are even eligible for surgery.
If a patient does not complete those courses, they must start again, which can make some people lose motivation. The lower levels of support are absolutely necessary and effective for the appropriate patients, but it would be better to remove the loopholes and duplications. That would allow more people to achieve the appropriate support, even before additional resource is provided.
Currently, the United Kingdom performs 5,000 bariatric surgeries every year, which represents just 0.2% of eligible patients. If more people had the opportunity to have that bariatric surgery, they would probably take it. Can the Minister indicate what intention there is to increase the opportunities for surgery? We lag behind our European counterparts when it comes to surgery for obesity, despite it showing benefits in terms of cost, safety and the ability to reverse type 2 diabetes.
Many reports in the papers in the last few months have indicated how people can reverse their type 2 diabetes and the implications of that. Talking as a type 2 diabetic, I am ever mindful that if people do those things and reduce their weight, it helps, but it may not always be the method whereby type 2 diabetes can be reversed. When I lost that weight, I found that my sugar level was starting to rise again after four years, and I moved on to tablets and medication, which controls it now. Ultimately, the control will be insulin, if the level continues to go the wrong way.
The British Obesity and Metabolic Surgery Society has recommended that the number of surgeries should increase incrementally to 20,000 a year—a massive increase from 5,000, but we believe it will heal some of the physical issues for the nation. This is a small proportion of the total number of people with obesity, but they would also benefit the most. This debate is not about highlighting the issues, but about solutions. I always believe that we should look at solutions and try to be the “glass half-full” person rather than the “glass half-empty” person, because we have to be positive in our approach.
For people who require nutritional, exercise or psychological advice, face-to-face services were closed during the first wave of the pandemic. I understand the reasons for that. While digital and remote services can provide help to vulnerable people during lockdown, these new ways of working cannot reach everyone. How do we reach out to all the people who need help? That is vital as the country moves through future stages of the pandemic. We hope we have turned the corner, but time will tell in relation to the trialling for the new vaccine. Obesity continues to be a priority, and services should remain available.
Lastly, in future, obesity services should not be cut as part of difficult funding decisions. I understand very well the conditions in the country and the responsibility that falls on the shoulders of the Health Ministers not just here in Westminster, but in Scotland, Wales and Northern Ireland. It is vital that the inequity in access to these services is corrected to ensure that people can access support, no matter where they are in the country. What discussions has the Minister had with the regional Administrations—with the Northern Ireland Assembly and particularly with the Minister, Robin Swann, and with our colleagues in Scotland and Wales? If we have a joint strategy, it will be an advantage for everyone. I would like to see the person in Belfast having the same opportunities as the person in Cardiff, Edinburgh, London and across the whole of this great nation.
I have three asks of the Minister, along with all the other questions I have asked throughout my speech—I apologise for that. Can she reassure us of the continued political prioritisation of the prevention and treatment of obesity? I call on the Government to implement, evaluate and build on strategies to reduce obesity. Can the Minister tell us how have discussions on that been undertaken with the regional Administrations across the UK? I also call on the Government to work with local NHS organisations and local authorities to ensure that services are available to our constituents who wish to manage their weight.
In summary, given the range of secondary conditions caused by obesity—this also applies to covid-19—would it not be more prudent to address their underlying cause before they occur? I always think that prevention, early diagnosis and early steps to engage are without doubt the best way forward, and it would be helpful for the nation as a whole if those things were in place. I believe that would help to reduce the impact of conditions such as type 2 diabetes, heart disease, kidney disease, high blood pressure, stroke, sleep apnoea, many types of cancer and more. The problem with covid-19 is that although our focus should rightly be on covid-19, we must not forget about all the other, normal—if that is the right word—health problems that people have, because dealing with those is very important for our nation to move forward.
The NHS currently faces huge demands, but reducing obesity now would significantly reduce demand on wider NHS services. It is a question of spending now to save later, if we are looking at the financial end of it. It is not always fair to look at the financial end, but we cannot ignore it, because there is not an infinite budget available to do the things we want to do; we have to work within what our pocket indicates. And we have to do that while also protecting people who are vulnerable to coronavirus.
I commend the Minister and our Government for their focus on obesity. I very much wish their new obesity strategy success. How it will work across the four nations is important, but we need to do more, in both the short and long term, to prevent and treat obesity, and we must do so with adequate funding, which is crucial to enable the operations, strategies, early detection and early diagnosis to be in place.
I hope that our future strategies to reduce obesity will continue to focus on how people can also be supported to live healthily. When it comes to these things, we have to be aware that it is not just one person who is living with the obesity; the family also live with it. Sometimes we forget about the impact on children, partners, wives, husbands and so on. Whenever someone sits down for a meal, is their meal the same as what the rest of the family are having? It would be better if they were all eating the same food, in terms of diet and content. I believe that if we can achieve that, we will find a way forward.
May I thank in advance all right hon. and hon. Members for taking the time to come to this Chamber and participate in the debate? Like me, they are deeply concerned about how covid-19 is affecting those with obesity issues. Today is an opportunity to address this issue, and I very much look forward to hearing other contributions; I am leaving plenty of time for everybody to speak.
Break in Debate
It is a pleasure to follow the hon. Member for Strangford (Jim Shannon). I congratulate him on initiating today’s important debate and on his thoughtful introductory comments. It is great to see the cross-party representation here today on this matter.
As a vice-chair of the all-party parliamentary group on obesity and a practising GP, I am only too aware of the significant health and financial implications of obesity. In the course of this year, a realisation of the link between obesity, its comorbidities and poor covid-19 outcomes has sparked renewed interest in tackling Britain’s obesity crisis. It is the case that 19.8% of critically ill covid patients are morbidly obese; that is almost three times the national average, which stands at 2.9%. And for those who are overweight or obese, the likelihood of dying from this virus is 37% higher than average.
There are of course numerous international league tables that rank covid’s impact on countries, and many people have suggested that the UK’s unenviable position in those tables is due at least in part to the fact that the number of overweight or obese individuals in the UK stands as high as 67%. Of course, obesity is frequently an outcome of poor life chances, but it can also perpetuate them. The economic impact of obesity cripples some of our communities, and tackling it is therefore a matter of social justice. Obesity rates among the most deprived 10% of the population are more than twice that for the least deprived 10%, and the gap in prevalence of obesity between rich and poor is, tragically, still growing.
My constituency in many ways epitomises the national picture. I can travel from one area, a coastal pocket of deprivation and the poorest ward in Wales, where obesity and poor health go hand in hand with economic inactivity and high premature death rates, to another area, just several miles away, where the average body mass index is markedly lower and life expectancy and income levels are significantly higher. To me, that inequality within a single constituency is unacceptable. Not only is reducing obesity levels vital as we seek to minimise the impact of the pandemic; as an issue that I fear will become even more important in the aftermath, it should also be considered a critical element of the Prime Minister’s levelling up agenda.
The harsh truth is that obesity is strongly associated with a number of serious health conditions, including many leading causes of death. It is also associated with poorer mental health outcomes and reduced quality of life. Being overweight can exact a tough emotional toll, from bullying at school to the pain of lifelong judgmental attitudes and stigma.
The overall societal cost of obesity is estimated to be £27 billion a year, saddling the NHS with an annual bill of several billion. As a GP, any day’s work reinforces to me that we live in a society where the freedom to make the right choices is severely constrained for some. Supermarkets are packed with temptingly priced, high-fat, sugar and salt—HFSS—products. There are takeaways on every street corner, bountiful coffee shops serving syrup-laden flavoured drinks, and pubs and bars offering large, 200-plus calorie glasses of wine. We have a culture that normalises these things on a day-to-day basis. It is far too easy for all of us to consume more calories than our sedentary lifestyles can withstand.
While some may navigate this environment unscathed, making healthy choices has become increasingly difficult, even more so in poorer communities. Whether under enormous stresses and strains from other aspects of life or fighting to feed a family on a tight budget in limited time, the long-term health outcomes of what we eat and drink may not always be our top concern. The measures we need to implement are not about taking away choice, but about the Government helping to rebalance the playing field in favour of healthier options, for the benefit of all.
In July, the Government published a new strategy, “Tackling obesity: empowering adults and children to live healthier lives”. This committed the Government to introducing a new campaign to encourage all those who are overweight to take action with evidence-based tools and apps. We should not forget the huge impact of exercise and dietary advice; in my experience we often have a very poor understanding of what is healthy.
The strategy also committed the Government to expand weight management services via the NHS; to consult over improving the traffic light system on food labelling; to legislate to require large, and potentially smaller, restaurants, cafés, and takeaways to add calorie labelling to the food they sell; to consult over calorie labelling on alcohol; to legislate to end the promotion of HFSS foods through product placement, online and at the end of supermarket aisles; to get rid of “buy one get one free” offers relating to unhealthy foods; and finally to ban the advertising of these same products online and before 9 pm on television.
These proposed measures follow on from apparent success through reformulation and the soft drinks industry levy, which has reduced the levels of sugar consumed from soft drinks. I have been pleased to join many others in pushing for such measures in my time on the Health and Social Care Committee, particularly as part of the childhood obesity strategy. Obesity in children at reception age currently stands at 9.9%, reaching 21% in year 6. We know that children with obesity are more likely to develop complications and disability later in life at a younger age, and there is a continuously worsening picture year on year.
With this in mind, we need to consider going beyond the measures in the Government strategy. If we look at the world through the eyes of children, I feel we need to attempt to tackle issues such as the location and quantity of fast food outlets on a cross-governmental basis. I would be pleased to hear the Minister’s perspective on this and also when a timeline might emerge for implementing the remainder of the Government’s obesity strategy. Further, how will the Government ensure that support is available across the country and includes those with severe and complex obesity, for whom diet and exercise alone are not sufficient? How and when will weight management services and bariatric surgery become more accessible?
In the immediate future, how do the Government intend to ensure that those living with obesity will be among the first to receive the covid-19 vaccines that we have heard so much about in the last day or so? Looking to the longer term, how do they intend to ensure that tackling health inequalities through the levelling up agenda will proceed despite the huge financial impact of the pandemic?
To conclude, the Prime Minister’s obesity strategy announcement in June created welcome attention and dialogue, which have been continued through an all-party parliamentary group inquiry, today’s debate and, it is now likely, Government action. However, it is vital that we keep up the momentum, especially given that the covid-19 pandemic is still, sadly, very much with us.
It is a pleasure to take part in this debate with you in the Chair, Mr Davies, and I congratulate the hon. Member for Strangford (Jim Shannon) on introducing this important issue. It is also a pleasure to follow the hon. Members for Vale of Clwyd (Dr Davies) and for South West Bedfordshire (Andrew Selous). The hon. Member for Vale of Clwyd is a GP and the vice-chair of the all-party parliamentary group on obesity, so he speaks with great authority on this subject.
I believe that we have to focus on the social inequalities that are at the very bottom of this issue. Let us tackle it from that perspective. Obesity is, of course, a major problem and can greatly increase a person’s risk of other health conditions. It is absolutely right that supporting people towards a healthier weight is a Government priority, and I fully support it. Any strategy aimed at tackling obesity must recognise that it is a complex condition with many underlying causes, including factors tied to socioeconomic issues. Managing weight is often not simply a matter of just eating less and exercising more. Unless that is recognised, this strategy will not be effective in the long term.
I want to say something about my experience as a councillor. Before I became a Member of Parliament, I was a councillor in one of our most deprived councils, and 10 years ago we tried to ensure that children learned how to eat healthily. If people cook their own food at least they know what is in it, so we tried to ensure that people knew how to cook. We then recognised, going even deeper into that, that a lot of families did not even have the means to cook. Some of the children had never seen water boil.
Those are the issues we face if we are talking about how to teach children early how to eat healthily, cook their own meals and know what is in their own food. Some families are at that level of deprivation: children have not learned to cook and have not seen their parents cook. That is how deeply we need to get into the issue. We need to understand that, without stigmatising families who live like that and without using language that shames people who are overweight. We must understand that, additionally, there are mental health problems and other deeper underlying problems that go with this issue. I urge the Minister to go deeply into that subject and recognise the social inequalities that lie at the bottom of it.
I want to talk about one particular aspect of the strategy that concerns me—calorie labelling in restaurants. There is limited evidence to suggest that that measure has a meaningful impact on tackling obesity. Worse still, it could be harmful for those at risk of living with or recovering from an eating disorder; that is, of course, at the other end of this problem. There is an epidemic of people suffering from eating disorders such as anorexia and bulimia and being underweight. Approximately 1.25 million people suffer from an eating disorder in the UK. It is also true that many people living with an eating disorder also live with obesity. Treatment, therefore, is not as simple as consuming fewer calories. The eating disorder charity Beat is one of many voices sharing concerns about that aspect of the obesity strategy, and I ask the Minister to look carefully into that concern. Calorie counting is well recognised as an unhealthy behaviour: one sufferer described it as an “all-consuming obsession” that “took over my life”. Learning to disregard calorie counts is a large part of recovery from an eating disorder. Having the freedom to go to a restaurant with friends or family—something that many of us take for granted—can be a very big step.
I highlight a quote from one of Beat’s volunteers:
“One of the greatest joys of recovery is being able to go to a restaurant for a meal with friends, and I enjoy going out now with my friends and family, but I really struggle to eat in public once I have noticed the calories. Once I have seen the number, I can’t stop my brain telling me I can only have the food with the lowest amount of calories.”
Research shows that individuals with anorexia or bulimia are more likely to order significantly fewer calories when that information is provided.
Eating disorders and obesity can in many ways be part of our somewhat strange relationship with food. People can go from obesity into bulimia—these things are connected—and it is important that we recognise that. I was extremely grateful to the mental health Minister for meeting me and representatives from Beat a few weeks ago. I appreciate the time she spent listening to our concerns about this element of the strategy, and I know she is committed to supporting those with an eating disorder. As chair of the all-party parliamentary group on eating disorders, I would welcome the opportunity to have another meeting with her and representatives of Beat to talk about that particular, very concerning aspect of the obesity strategy.
Yes, we absolutely need to recognise that obesity is a massive public health issue. We need to tackle it, and I welcome the fact that the Government have made it a priority. But it is important that we make sure that the strategy does not hit people with an eating disorder, such as anorexia or bulimia, in an adverse way.
Of course we look at all the impacts of all the policies, but we know that the more targeted a policy can be, both in terms of the measures and the geography, then the less disruption it will have. If the hon. Gentleman’s concern is with a national circuit break, that is not the policy of the Government; the policy of the Government is to have a localised approach. He might therefore want to have a word with his own Front Benchers.
I would be cautious about some international comparisons, because life is not exactly back to normal and there are restrictions still in place. For instance, we have seen today Sweden introducing restrictions on a regional basis, which is similar to the approach that we have here. There is a lot of debate about international comparisons, and we do look across the board, but I am not sure it is true to say that life is back to normal in in Wuhan. We need to get the science to come to our aid and help us to get life back to normal here as quickly as possible.
I welcome the very constructive approach that the hon. Gentleman takes in his local role as well as in this House. Of course, we have put in the extra funding that the NHS needs this winter. We are expanding over 140 emergency departments, because emergency departments need more space so there can be social distancing. We have also put in funding so that we can continue the work on electives, even though it is more difficult, and on infection control—and, of course, as much discussed, on testing. I look forward very much to working with him further as we try to control this virus.
Yes, my hon. Friend makes a very important point, which is that we have got to learn from things that have worked in other countries. We are constantly looking around the world as well as at the domestic science. I am very happy to work with him to see what further we can publish in terms of the assessments that are made and then presented to us as Ministers to make decisions on that constitute that scientific advice.
The hon. Lady is absolutely right that Luton is an example of local action that worked to bring the case rate right down. The outbreak was specific to certain parts of Luton. The council worked with the national bodies brilliantly.
Over the last week in Luton, about 3,000 tests have been done, so those tests are available. I look forward to working with the hon. Lady to make sure that people who have symptoms are able to get the test.
This is the central point: if people do not have symptoms, but they have been close to somebody who has tested positive or has symptoms of coronavirus, unfortunately they have to self-isolate because of the biology of the virus, which can incubate for up to 14 days. Even a negative test does not release them from that obligation, because they may well get a false negative. That is at the core of how we control this virus. The more colleagues around the House explain that principle, the more we will relieve pressure on the testing system and break the chains of transmission of the virus. It is an incredibly important point for us to communicate to all those we serve.
Of course, as the hon. Lady well knows, we are working both to increase capacity and to ensure that we have prioritisation so that the people who need a test most can get access to those tests. I am sure she will agree that it is important not only to listen to voices and the stories of those people who have had difficult experiences, but to ensure that we look at the facts on the ground. There were 762 people yesterday who got a test in Coventry, and that is an increase over the previous week. I am really pleased that we are able to do hundreds of tests a day in Coventry, but I appreciate that we need to keep expanding capacity.
I have looked very closely at the situation in Sweden, and the challenge is that Sweden brought in significant laws curtailing social activity and that the population in Sweden followed more closely more than in almost any other country in the world a lot of guidance that was not enforced by law. The case rate in Sweden was also higher than in other geographically comparable countries.
The conclusion I have come to is that the approach we are taking, where we look around the world, learn from similar countries and take action where necessary, is the best way to control the virus and protect the economy. The rule of six is designed to try to restrict the transmission where we see it happening most, which is in social circumstances, and to protect the economy as much as possible by keeping the economy open within those social constraints. We are constantly vigilant and we are looking around the world for other examples of where we might be able to make changes. As my hon. Friend knows, we have made changes to our approach as we have learned throughout this unprecedented pandemic.
I very much agree with the hon. Lady’s sentiments; the challenge is that the number of different groups within shielding is essentially as big as the number of people who are shielding. We have taken the approach that individuals will get individual clinical advice on what is right for them. That is the best way forward.
The explanation is that in the pub they will have to be socially distanced at 2 metres, or 1 metre plus mitigation. Unfortunately, this virus is still at large, so having very large groups of people in a situation where it is absolutely normal to be in very close contact is a risk. These are all judgments and unfortunately that is one of the judgments that we have had to make.
It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), whose personal leadership on tackling modern slavery is something we very much appreciate in this place. We may well have seen a reminder today of why that is more necessary than ever.
I made my maiden speech in a Queen’s Speech debate. Google tells me it was 848 days ago, which feels very strange. It simultaneously feels like a lifetime ago and like yesterday. These have been very strange and tumultuous times. If I had been told then about things that have happened subsequently, I would have been sceptical, but no more sceptical than at the idea that we would still not have a social care Green Paper. We have had five delays and, despite it not being a laughing matter at all, it has become a long-running joke and a focus of derision.
The ever-delayed social care Green Paper is absolutely critical, because we know that up and down the country millions of people, paid and unpaid carers, are getting up in the dark, coming home from work in the dark, working split shifts and double shifts, and working for poor pay on insecure contracts. They are the backbone of not only the social care system, but the NHS and all public services. If only 10% of our social carers, whether paid or unpaid, walked away tomorrow, all our public services would come to a grinding halt. We need to do much, much better by them. I hope the Government, in showing movement on this issue, intend to bring forward their plans quickly.
In its latest annual assessment, the CQC highlighted concerns about cultural and geographic barriers to access to care, deficient regional staffing, a lack of stability in the adult social care market, and the Government’s failure to implement a sustainable long-term plan to fund social care. It said that that directly impacts nearly 1.4 million older people and millions of people with disabilities or illness who do not have access to the care and support they need. It is time for us to act.
The Government need to be brave and honest. If they are worried about the reaction of current service users to their proposals, I would remind them that the current service users have lived experience of the fact that the current system does not work, so they have no need to be afraid of them when it comes to change. When it comes to millennials like me, we are realistic. We know that the system that cares for our grandparents and our parents will not be the same for us. Let us be honest about that. There are profound and difficult decisions that have to be taken—let us get to that point. We do not need to be afraid.
I know that the Minister for Health, the hon. Member for Charnwood (Edward Argar) is a good and honest man, but when it comes to funding for social care—this is a really important point—we always see the Secretary of State or the Prime Minister use phrases such as, “We have given access to an extra £11 billion”. The Government should be honest about where that money comes from, because the bulk of it is from a social care precept on the local ratepayer. There is a political argument—I disagree with it fundamentally—that says, “Well, the Government believe that there should be a transition of the burden for social care from the national taxpayer to the local taxpayer”. I disagree, but if that is the belief on funding the social care system, the Government ought to say so, because that is very important.
Similarly, I know that this is a health debate, but I will not miss the opportunity to say that we must all reflect for a moment on the BBC and the removal of the free TV licence. As part of someone’s care, and as part of someone’s life in their 70s and beyond, we know that television plays an important part. We should be honest about why this has happened because that cut lands at the door of the Government, despite what they might say.
We know that failures in social care have a profound impact not only on the individual, but on the national health service. I have a real passion for integrated care—I cannot quite see the shadow Secretary of State from where I am standing, but when I was his Parliamentary Private Secretary, I used to bore him at great length about the virtues of integrated social care. When I was health and social care lead in Nottingham for three years, it was by far the least popular thing I did and I had campaign groups at my door weekly talking about my enthusiasm for certain models. There were flaws in the models for sustainability and transformation plans, accountable care organisations and accountable care systems—whatever re-branding we are on at that moment —but, fundamentally, integrating the national health service with our local authority social care is a very good thing and, if we did it properly, it would lead to people not having to ring up multiple agencies to sort out their loved one’s care. It would lead to proper, seamless care that, rather than being based around organisations, would be based around individuals. Again, I say: Ed, let’s be bold on integrated care. Let’s be brave —[Interruption.] Madam Deputy Speaker wasn’t concentrating, I got away with it. Let’s be bold about this. If you are, you will see the best of politics working and a lot of consensus building.
I want to use the limited time available to me to refer to public health. I am proud of what I said on integrated health and what we did in Nottingham—we did good things. One area from my time in local government that I reflect on without pride is public health. We did good things on trying to be more innovative with the public health grant, but fundamentally, because of the nature of the cuts that have come down the line over the last nine years, we made cuts to public health services. I made cuts to smoking cessation services—a terrible public policy decision—because there simply was not enough money.
We have recently announced that the way in which we are going to proceed with regard to sexual health services is co-commissioning between local authorities and the local NHS. This is the best way to ensure that we get the services on the ground. I would just slightly caution the hon. Gentleman; although he mentioned that some sexually transmitted diseases have been on the rise, others have been falling quite sharply. We have to ensure that we get the details of what we try to implement right, but I support the direction of travel that he proposes.
My hon. Friend is dead right. This is an important part of the work that Baroness Dido Harding is leading in the NHS people plan to ensure that we can make careers in the NHS—whether as doctors, other clinicians or more broadly—the most attractive that they possibly can be. This week we announced a pay rise for doctors and earlier this month we announced a long-term agreement with junior doctors, which I am delighted they accepted in a referendum with over 80% support. But there is more work to do.
I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.
First, I will say a big thank you to the hon. Member for Congleton (Fiona Bruce) for having set the scene. She is always a strong supporter of marriage, and I wholeheartedly support the issues that she brings before this House, whether here in the Westminster Hall Chamber or in the main Chamber. Furthermore, without speaking for the hon. Lady, whenever I bring issues to either Chamber, she is always there to add her support. I thank her for that. She has been very much at the forefront of ensuring that National Marriage Week and the issues of family life and family values are heard about in this House whenever the occasion arises. It is a real pleasure to speak in this debate.
Marriage is a wonderful thing but, like all things of worth, it is not easy. In all honesty—I speak as someone who, on 6 June, will have been married for 32 years—I have a very long-suffering wife. The truth of the matter is that she has suffered long and hard, but she is still there, and that is one of the good things about married life. If my dad had lived another two weeks—he has been dead for four years—he and my mum would have been married for 61 years. They were a long time together, and that is not counting the time they were going together way back in the early ’50s. I have no idea how and why my wife Sandra has stuck me for so long, but I thank God every day that she has.
A strong marriage requires two people who choose to love each other even when there are times they do not particularly like each other. That is the fact of it. If Sandra was here, she would say, “Amen to that.” She would wholeheartedly know what I mean when I say that, because we have some exchanges of opinion now and again. I think it is good to have those release valves. It does not mean we have fallen out; it means we can have differences of opinion. My wife is not politically motivated at all; she only became interested in politics when she married me. The fact of the matter is that whenever I bring up issues to do with politics, truthfully she is perhaps not that interested, but she supports me well and she has an opinion on political matters. She is quick to tell me about those things.
Marriage is tough, and my heart goes out to those who are unable to make things work despite the hard work put in. The reality is that relationships break down. That is a fact, even with the best relationships. No one gets married to get divorced; people get married to spend the rest of their lives together. That is how it happens, but sometimes things happen along the way. As elected representatives—we are all here speaking in this debate as elected representatives—we are probably confronted every day in our advice centres with people who have had marital breakdowns. If they are churchgoers, I genuinely usually say, “Have you spoken to your minister?” If not, I say, “Have you had a chance to talk things through with someone in Relate to see whether it is possible to pull things together?” Sometimes that works. I am not a Relate councillor with great skills, but I try to point people in the direction where some things can be brought together. That sometimes works, but it does not always work. Sometimes when they come to me as the MP, or when they did in my past life as a Member of the Legislative Assembly, things have broken irretrievably. Those are difficult times.
I read an incredibly interesting report by the Marriage Foundation, which had some noteworthy analysis and statistical presentations. Analysis carried out on the millennium cohort study data on 10,929 mothers with 14-year-old children reveals that mental health problems are especially prevalent among children whose parents split up. We have just finished the main inquiry on education in the Northern Ireland Affairs Committee. Some of the figures on education in Northern Ireland are truly scary and worrying. We have the highest levels of anxiety and depression among children of primary school and secondary school age for the whole United Kingdom. That is very worrying. This debate is so important—the hon. Member for Congleton has referred to it—because it shows the importance of having a normal home life. I say that honestly, because having that does in some way help things.
It is incredibly difficult for a child to watch a break-up, and all too often they are in the middle. It happens so often. I thank every parent who makes the determination that, regardless of the relationship status, they will not allow their child to be a pawn or used as a weapon. A story came to my memory when I was sitting here. There was a sad, sad story last weekend in one of the papers. A mother and father were breaking up and they had two children from that relationship. The really sad thing was that neither the mother nor the father wanted custody of the children. I said to myself, “How sad is that?” Neither the mother nor the father felt that the children could be with them and they wanted the other one to have them. I do not know what the outcome of that will be. Sir David, you and I have talks about many things. You are chairing this sitting, so you are independent, but I know that you and I very much agree on the importance of married life and what it does for a relationship and the children that come out of it.
I have three sons from my relationship with Sandra. Two of them are married. The big fella, Jamie, has been married 11 years, and the second married just last year, and out of that comes the grandchildren. We could never get a wee girl—it was always wee boys—but Sandra always wanted a wee girl. She now has two wee granddaughters, Katie and Mia, and just before Christmas a third grandchild was born to my second son, who was married just last year—the product of that is a wee boy called Austin. How much do we as grandparents enjoy the grandchildren, ever mindful that at 7 o’clock at night we can give them back? That is a big, big thing. We get all the enjoyment, smiles and laughter, but when they get tantrum-y and want to go or argue, we can phone up to say, “They’re ready for going home.” That is always something to remember, but I say it because of the enjoyment they give to us as parents.
The findings show that the influence of family behaviour on teenage mental health extends far beyond parental conflict. Family breakdown is the single biggest factor for girls and equal top influence for boys, along with parental relationship happiness. Whether parents are married and happy, and stay together and remain close to their child all make a unique contribution. I believe that parents have a strong responsibility; they need to be reminded that children watch and note their every word, action and deed. Therefore, the role of the parent is critical in setting an example for children in how the family gets on together.
The positive effect of marriage on mental health is clear and there for all to see. It is particularly interesting that the Marriage Foundation study showed that the effect of marriage extends well beyond stability and selection effects. For boys, whether their parents were married when they were born remains one of the two biggest influences on their subsequent overall mental health, even after taking into account their mother’s age, education, ethnicity and relationship happiness when the child was born, and whether the parents stay together. We cannot ignore—and nor can parents—the influence that parents have on their children.
The 2016 report by the Marriage Foundation found evidence that marriage boosts self-esteem for boys and girls. It is good that that happens. The report relied on the data of 3,822 children from the British household panel survey. It revealed that teenage boys living with continuously married parents have the highest self-esteem, while teenage girls living with continuously cohabiting parents have the lowest. The data outlines that the mother’s education has a smaller effect on self-esteem, while the child’s age and the mother’s income have no effect at all. Some of those stats are particularly illuminating because they give an idea of how what happens in the family home can affect children. Although those differences are all relatively small, they are highly significant and provide robust evidence that the wellbeing of teenagers and their future life chances are influenced by whether or not their parents are married. I am not making it up—the stats come from organisations, and they cannot be ignored.
Teens of either sex who live with continuously married parents have higher self-esteem and acceptance than those who live with continuously cohabiting parents or other family types. In outlining all this, I must be very clear: I do not believe that if a family is not united by marriage, a bad outcome is predetermined—it is not; far from it—but I am referring to the findings and how the information was collated. Data shows that children from married families show a higher level of wellbeing and mental health. That should be noted and highlighted.
The institution of marriage, to which I happily subscribe, has stood the test of time, and its benefits to society are clear. I believe that the House must acknowledge that, which is why I am so happy to support my friend, the hon. Member for Congleton, and I thank her for allowing us to highlight that wonderful institution once more. I am someone who is convinced of the benefits of marriage, and in June, my 32 years of marriage will be an example of just that.
In some respects, it is nice to have a slightly relaxed atmosphere in Westminster Hall, because that gives us the opportunity to consider issues in detail. I congratulate the hon. Member for Congleton (Fiona Bruce) on securing the debate. It is a happy coincidence of the calendar that Marriage Week and Mental Health Awareness Week have fallen on the same dates, because that allows us to consider how marriage and mental health relate to each other. We should also note the general importance of awareness weeks and the work of the organisations that support them, because they give us an opportunity to raise issues in the House and press the Government on their commitments.
I congratulate the Marriage Foundation on promoting Marriage Week, which I believe has been marked for the past 22 years—not quite as long as the hon. Member for Strangford (Jim Shannon) has been married, but not far off. I also congratulate the Mental Health Foundation, which has worked on mental health issues for more than 70 years. I am actually wearing a tie with the mental health tartan, which was developed by Support in Mind Scotland as a colourful way to promote mental health awareness and understanding.
As we have heard, Marriage Week is all about the ingredients of positive and healthy relationships, which are at the heart of a successful and vibrant society. Families and relationships bring meaning and purpose to people’s lives, and they come in all shapes and sizes, as the hon. Member for South West Bedfordshire (Andrew Selous) said. Governments have a responsibility to support them by providing good-quality public services and fair work practices to ensure that people can live healthy and fruitful lives. When people feel supported by such services and by a positive sense of community, relationships can flourish. That is an ambition of all Governments, no matter what their political character may be or in which part of the United Kingdom they may operate.
It is right to stress that not all marriages are happy or end as happily as they began. It is important to have services and support in place to help those partnerships to move forward as positively as possible. In Scotland, a lot of support is provided to national family support organisations, such as Relationships Scotland and The Spark. As the hon. Gentleman also said, that importance is particularly true in making sure that the support is there for children, whether mental health support or mediation.
As the hon. Member for Strangford said, people present at our surgeries and we, as Members of Parliament, have an individual responsibility to signpost people to the right organisations and to be aware of the range of support services available nationally and in our communities.
Marriages come in all shapes and sizes, and Scotland was of course the first country in the United Kingdom to consult on same-sex marriage and subsequently to legalise it, through the Marriage and Civil Partnerships (Scotland) Act 2014. That has been a cause of great celebration, including among close friends of mine.
Not every marriage, however, is made through free choice. That is why we must also recognise the importance of having robust legislation in place to protect against the appalling practice of forced marriage and to ensure that marriage is not a misery or a trap. The Scottish Government introduced forced marriage protection orders to protect people from being forced to marry, or who were already in a forced marriage. In September 2014, that protection was extended to protect those at risk and to make forcing someone into a marriage a criminal offence in Scotland.
By coincidence, there was a particularly high-profile exponent of marriage in the news last week. The First Minister of Scotland, Nicola Sturgeon, gave an interview to her local station, Sunny Govan Radio. She was asked what had surprised her in recent years, and she said her marriage had surprised her:
“I had always been a bit of a feminist and never really considered marriage as an option. When Peter and I decided to get married, it was immediate how much more strong and stable I felt knowing that I had him at my back. His support and the support of my mum and dad give me the resilience and strength to keep going every day and doing my best.”
I hope those are words of encouragement to everyone who is considering marriage. Nobody is an island. None of us politicians is an island. We all have colleagues who have experienced difficulties and intimidation. When you are the one person in a room standing up speaking, that is difficult for any one of us. For most of us, it is the knowledge of the strong relationships in the background, whether marriage or other forms of partnership, or friends and family, that provides that support network that we rely on.
That point links to the importance of Mental Health Awareness Week. The First Minister went on to speak about some of the challenges and stresses that come with life in the public eye, particularly her experience of imposter syndrome. When asked if she ever feels like an imposter, she said:
“Like many women in senior positions, yes I absolutely do. However, I think it gives women a bit of humility too and reminds you that you have to work hard for what you need to achieve. It keeps you grounded. Do I deserve this? Could I do better? It makes you more accountable for your own work.”
That level of self-awareness and her willingness to speak out should be an encouragement for everyone in public life and beyond. It is important to use such opportunities to raise awareness of the issues.
The main focus for Mental Health Awareness Week this year is body image—a subject that has become topical in the last few days with the issues that led to the cancellation of “The Jeremy Kyle Show” and questions about “Love Island” and other reality TV programmes. Sometimes, frankly, this job can feel like a bit of a reality TV programme, though it is less likely to be slated for immediate cancellation. Using the opportunity of awareness weeks to turn the debate on social media around and to try to detoxify online culture is hugely important. We must support people who champion body positivity online and make sure that people who are struggling with those kinds of issue, especially young people, interact with social media content in a healthy way and avoid falling into mental spirals.
The Scottish Government have made several announcements to try to support that this week. They are setting up an advisory group on healthy body image, which will include members from youth, third sector and equalities groups, to identify steps that can improve support for young people and advice for relevant professionals. That will build on a package of measures to improve young people’s mental health, including £90,000 in funding to provide advice on the healthy use of social media and screen time, and a review of evidence on the effects of screen use on sleep and its implications for mental health.
We will continue to drive that forward and, again, I hope there will be lessons that the Governments can learn from each other. The hon. Member for South West Bedfordshire spoke about how such issues can be championed in Government. The Scottish Government have a dedicated ministerial post for mental health. The occupant, Clare Haughey, was herself a mental health nurse and brings significant personal experience to the post. The desire to see mental health issues mainstreamed across the NHS and other support organisations runs right across the national strategy.
Like other hon. Members, I see fantastic examples in my own constituency. The members at Flourish House, part of the global Clubhouse Network, presented me with this tie the last time I met them. They wanted to engage with me on different aspects of how Government and public policy affect people with mental health issues, particularly on questions around welfare reform, but also other aspects of social care and the health services. Flourish House does a fantastic job in reducing social isolation and providing different kinds of activity and engagement for its members. Similarly, the Coach House Trust provides a particular focus on employability and skills. It has been doing so for more than 20 years and has an annual open day that is a highlight of the summer calendar. We are always spoilt for choice with the arts and crafts available for sale that have been produced by their members over the years.
I also pay tribute to a group called Differabled, which was founded by parents in my constituency to provide support for other parents and carers of children and young adults with a range of additional support and mental health needs. I met them during the 2017 election campaign and it was an incredibly powerful experience. The way that organisation has developed is incredibly impressive, and I continue to support it.
The Glasgow Riding for the Disabled Association helps to promote the mental health benefits of physical activity and physical exercise in different ways. It was the beneficiary of the Christmas card competition that I ran in my constituency last year. Last year and the year before, the winners of the competition came from two of the schools that provide support to children with additional needs and mental health issues. East Park in Maryhill has been supporting young people since 1874, and Alexander Houston was a worthy winner of last year’s competition. Abercorn Secondary School, which is supported by the local authority, provides a fantastic supportive environment, and Jack Slavin’s Christmas castle featured on my card in 2017. Kelbourne Park Primary School, in North Kelvinside in my constituency, supports younger age groups in a wonderfully nurturing environment. I use this opportunity to offer them my full support.
There has been a fair degree of consensus in this debate, particularly on the importance of stability in relationships for good mental health, and the benefits that that has for wider society in promoting social justice and tackling poverty, and the many different things that, in our different capacities, we all came into politics to try to achieve. There is a challenge to the Governments in the United Kingdom and the devolved nations to ensure that adequate funding is in place for the different services and that the appropriate legislative frameworks are in place to support families and the various organisations that work with them.
I hope the Chamber will indulge me, because on 1 June, during the recess, I will be attending a wedding of two very good friends of mine, Emma and Adam. I have known Adam Sutherland since we were very young. Of course, people are a bit older when they get married these days, so their chances of being married for quite as long as the parents of the hon. Member for Strangford probably depend on a variety of factors, but the strength of their relationship will be a solid foundation for many long years of happiness, and I hope the Chamber will join me in wishing them all the best.
NHS Improvement has a number of retention schemes in place, for GPs and for nurses, to look at why some people are leaving. The interim plan being developed by Baroness Harding has an employer of excellence work stream, which will report on a number of potential issues.
I beg to move,
That this House has considered services for people with autism.
Every year, my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan), in her role as chair of the all-party parliamentary group on autism, moves a motion along the lines:
“That this House notes that World Autism Awareness Week runs from 1 April to 7 April; observes that autistic people continue to face a number of barriers to full participation in society; notes that it is 10 years since the Autism Act became law; and calls on the Government to improve support for children and adults on the autism spectrum, and ensure that the Autism Act is fully implemented across the country.”
My right hon. Friend cannot be with us today. She has asked me to explain that a close family member is critically ill and that she cannot leave their side. Though you, Mr Deputy Speaker, I send the love of this House to our right hon. Friend. She is a formidable champion of this cause, and someone to whom many of us have turned in our own hour of need. The best tribute that I can pay to her is to deliver the speech that she prepared and would have made today. These are her words:
“I welcome the Minister to the Front Bench and look forward to hearing what she has to say. My thanks to the Backbench Business Committee for granting this debate as we look forward to World Autism Awareness Week, a full seven days when people across the UK take part in activities to raise awareness of autism. I also thank the National Autistic Society for its ongoing support for the all-party parliamentary group on autism.
Hon. Members will be aware of my long-standing commitment to improving the lives of people on the autism spectrum, most notably through my role in spearheading the introduction of the Autism Act 2009—which has now been on the statute book for 10 years.
I was proud to introduce that Bill that became the only Act—which is the only Act dedicated to improving support and services for one disability. It was a landmark in the battle to improve the lives of autistic adults and their families. As a result of the Act, there has been a fundamental shift in how policy is developed and delivered for adults on the autism spectrum. For the first time, legal duties were placed on councils and the NHS to provide support to autistic adults in their local areas. In addition, the Act placed a responsibility on the Government to produce the national autism strategy, to set out its vision—and, importantly, to keep that strategy under review.”
I thank my hon. Friend for his words and for championing his constituents. As he rightly says, some autistic people tend to fall through the gaps. Of course, all local authorities have a responsibility to take note when it comes to autism. We see individuals who are on the autism spectrum but are not receiving help because they might be outside a defined period. The extension of plans up to the age of 25 will go some way towards addressing that, but we still see people falling through the gaps. I will touch on some of the other areas that might address his concerns, or I will at least make calls to those on the Front Bench.
My right hon. Friend the Member for Chesham and Amersham continues:
“This year, it falls on the Government once again to review its strategy and identify what more needs to be done.
Each of us has about 1,000 people on the autism spectrum in our constituencies and it affects one in 100 people. We each will have many autistic people and their family members contacting us to ask for our help on areas from education to adult support, diagnosis to employment...”
I congratulate the hon. Gentleman on bringing this important issue to the House. As he said, 1.8 million elderly people across the United Kingdom of Great Britain and Northern Ireland have problems, which is shocking. The hon. Gentleman outlined some of the solutions such as extra attention on domiciliary care and in residential homes, and for those at home and dependent on carers. Does he agree that older people’s confidence can also be diminished by not having their teeth correctly done? My mother went this week to have her teeth done; she is 87 years of age and she depends very much on her dentist. She has attended over the years, but many have not, and we need to have that care at all those different levels.
Many elderly people are independent and proud, and one of the things that puts them off attending the dentist—I see this in my constituency—is that they think they have to pay for the treatment, but they do not. Perhaps we need to put out a reminder about that.
I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.
I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.
Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.
As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.
Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.
My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.
As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.
The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.
I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.
In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.
I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.
The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.
We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.
Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.
On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.
I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend he is kept informed on that point.
My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).
In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.
In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.
Question put and agreed to.
Thank you, Mr Davies. I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate, and I thank her for her support for new MPs who are also fairly new dads. I very much valued the advice that she gave to me in conversations in the Tea Room in my early days here, as I tried to struggle with the largely impossible balance of being an MP and having a young family.
I will touch on a few things from my own experience as a dad of two under-fives. Both my kids were born between midnight and 2 am. It is quite difficult, about 90 minutes after a child is born, for a father to have his wife and child go to the maternity ward while his is simply waved off to drive home. I am lucky; I live about 20 minutes from the hospital, the roads are good, and both my kids were born in May. Lots of dads will drive home in very difficult conditions and will be mentally, physically and emotionally exhausted. Would it not be nice if dads could spend a bit more time on the maternity ward in those early days? It sets the tone for how dads feel a lot in those early months—as if they are one step removed from everything that is going on around them.
After I went back to work, my two overriding emotions were guilt and jealousy, neither of which are very healthy. I felt guilty that my wife had to do all the legwork, and jealous of the fact that she was spending all the time with the kids. I really welcome all the stuff that is being introduced by NHS England—and now also up in Scotland—to try to include dads more in those early parts of the services. As my hon. Friend the Member for Chatham and Aylesford said, things are quite good on the pre-birth element. Dads go along to the scans and classes, but then they are just chucked to the side in a lot of ways. We need to involve dads much more.
A lot of the support groups are very helpful. I always used to try to get away from work as early as possible and rush home, and I wanted to do loads when I got home. My wife used to say to me, “Well, no, actually, I need you to be the best version of yourself, so don’t feel guilty about getting a good night’s sleep. Don’t feel guilty about going to the pub or seeing your friends, because if you’re in a better frame of mind and feeling better, then you’re a better support for me.” It is important to help new dads to have that confidence in what they are doing.
The last thing I want to mention is although new dads are lots of things, they are not counsellors or trained mental health professionals. It is very difficult for a dad if he is not sure whether his partner is just feeling a bit down or whether there is something that he should be more worried about. I will never forget my wife saying to me one day when she was a bit upset, “I just feel like my world is so small and I don’t know where I stand anymore.” I did not know what to do about that or whether it was something that I should be bothered about. If I am supposed to speak to somebody, who do I speak to? The health visitor comes when I am at work, and I am not going to speak to my colleagues about it. I am not going to sit at my computer at work and type in, “Is my wife depressed?” on Google.
We should not think of support for new dads as just support for them as individuals; we should think about it as supporting new dads to support their partners better. That is the best way to ensure that kids get the best possible grounding in their early years, and to keep a strong, solid functioning family unit that is needed to give children the best start in life.
Dads are good for lads—I know, because I have two boys—if only because they can share the interest of football. More seriously, it is true that fathers are good for sons in many ways. Anything we can do to support that relationship—and by we I mean the Government—we should do. I echo the respect expressed by others, which I share, for the herculean task that single parents—most frequently, mums—do to bring up their children. Where we can, we need to look at how we can strengthen family relationships in a society where, today, over a quarter of children live with mum but not dad. More than one in seven are born into homes where there is no dad present.
The implications of that are serious; I will share a couple of sad statistics. The lack of a good male role model in young men’s lives is helping to lure them into substitute families: gangs. Apparently, most of the 50,000 or so young people caught up in county lines activities have come from homes where there has been no good male role model. Similarly, 60% of the sons of men in prison are likely to end up in prison, too. That statistic is even worse if both the father and a brother are in prison—it is then a 90% likelihood.
Those are staggering statistics that show why it is so important that we and the Government try to support families more. That support is positive for children and for the wider community.
Break in Debate
It is a pleasure to serve under your chairmanship, Mr Davies.
I thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for securing this excellent debate. As I have tweeted, what a great group of Conservative dads are supporting the debate, although I feel slightly unhappy about speaking after three people who are young enough to be my children. That makes me feel a little bit old. I wanted to contribute because my early career highlights the difficulty that dads can have. I thank my first wife for being kind enough to have our children on a Saturday evening, which meant I was dismissed from the hospital, and about an hour after my children were born I was in the pub with about 30 friends and family celebrating the birth. It all turned out damned convenient for me, although having heard stories from others, I appreciate it can turn out differently.
I started life as a civil engineer, working on a building site in an obviously male dominated environment. I will not make excuses for that, but construction, particularly the very large-scale construction I was involved in, has a particular nature. The idea that I might have gone to work one day and suggested to my boss that flexible working would be a good idea, and asked whether I could come in a bit later, is incredibly difficult. By the time I was 25, I was running a building site with a gang of up to 50 blokes who would have thought I was crazy. We were on site at 7 o’clock in the morning in a process that meant that if someone did not turn up and do their job at a particular time, other people would not be able to do theirs.
Fortunately for me, I decided that working outside was too cold, and joined an American company called Cartus, where I was responsible for maintenance of the properties in its portfolio nationally. I found the world to be a completely different place. It was a much more welcoming environment with regard to flexibility in the workplace, but I may not have appreciated at the time the majority female workforce. I mention that because, in preparation for this debate, I read documents and papers from around the world, and I had not realised how difficult legislation is in America. I read a paper from the National Bureau of Economic Research, published in 2015, when a form of parental leave was just being introduced in California. The early research from that paper showed that if parental leave was introduced, fathers were more likely to be engaged in parental support, and that, interestingly, fathers are more likely to take up that parental leave for their first child or if the child is a boy.
Clearly, there is some work to be done to ensure that men do not lose interest after the first child and that they take equal interest in daughters and sons. I have one of each, and I appreciate the stress that goes with having a daughter. She seemed considerably more difficult for me to manage and look after than my son did. It is interesting that research suggests that there might be a difference in the way they are treated.
Government have a role to play, and that does not always have to cost money. We need to show intent; we need to show men that they have a role to play and that it is important in the 21st century that they play it to their fullest ability. For that not to be the case seems counterintuitive. I loved my role as a dad; in fact, I told colleagues earlier that I am ready to be a grandparent and I have made sure my children are aware of that. There is no rush, but I will be ready when they come. Indeed, the hon. Member for Hampstead and Kilburn (Tulip Siddiq), who recently gave birth, sent me a photo, which made me immediately feel paternal.
We have a role to play, but what will we do to play it? Documents have been mentioned, and “A Manifesto to Strengthen Families”, published more than a year ago, has some excellent ideas for Government to follow. As has been mentioned, we have a more significant male population in prison, so it is very important to ensure that men do not lose contact with their families. To reduce reoffending rates, we need to maintain that bond.
It is excellent and reassuring to hear of that progress. The point was also made about the amount of paternity pay—£145.18. When I started work on a building site, I earned £50 a day, so £250 a week. Even 30 years ago, it would have been very difficult for me, as a young man starting off with a young family, to cope on a reduced income of £145, for a couple of weeks. It is great that the opportunity is there for men to take two weeks of leave, but it is important to try to make sure that is not financially difficult.
This is a complicated area, so I conclude by referring my constituents in particular to the website of the Share the Joy campaign, where they can find more details of their rights with regard to maternity and paternity leave. They can get more details about sharing parental leave up to 50 weeks, so they can take leave together and share the parenting experience very early on in their children’s lives.
The hon. Lady asks about GPs. As she would want to acknowledge, a record number of doctors are being recruited into GP training. We are determined to deliver an extra 5,000 doctors into general practice. NHS England and Health Education England have a number of schemes in place to recruit more GPs and to boost retention—the GP retention scheme and the GP retention fund—and she will know, as I have said it twice this morning, that the workforce implementation plan, which is part of the long-term plan, will be published in the spring.
This Government are taking bold, world-leading action on child obesity that meets the scale of the challenge that we face. We have a soft drinks industry levy, a sugar reduction programme already working, measures on banning energy drinks, calorie labelling consulted on, and a consultation on restricting price and location promotions of sugary and fatty foods which I launched on Saturday.
I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.
I too congratulate my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) on this excellent debate. The contributions have shown that we could have spoken at much greater length, given the breadth of issues faced.
I will talk from a personal perspective. Two years ago I received a phone call from my doctor’s receptionist, who said that the doctor would see me at 4 o’clock. Not catching on, I thought that was somewhat strange as I had not requested an appointment. I explained that I was in the House of Commons and very busy. She said, “Well, how about 9 o’clock tomorrow morning?” I agreed to go along on Friday, thinking that perhaps there was some issue that was going to be raised as a Member of Parliament.
I had forgotten entirely that I had had a regular blood test following quite a serious illness. A few years ago, I was in hospital for the best part of a year, in and out, and at one point none of my internal organs, including my pancreas, was working. I was obviously on quite a lot of painkillers. One of the many things they had evidently said was that I could be diagnosed as diabetic in the future but, to be honest, during that period of my life I was pretty much out of it on painkillers, so I did not listen particularly.
I was completely aghast when I turned up at the doctor’s and he said, “You’re diabetic, and at the end of this meeting I will probably have to inject you with some insulin and you may be on insulin for the rest of your life, but there are other options.” In the end, he decided that he would try to manage it through other drugs initially and I never went on to an injection regime, but it was quite scary.
It was also, I thought, quite embarrassing. I felt rather guilty and perhaps stupid for having been obese. Ironically, because of my illness, I was quite thin having come out of hospital. I had lost about five stone in total, so I was not a typical case, but I had eaten too much and not exercised enough. I am now getting back on track and staying on track, but when, as Members of Parliament, something happens to us, we have an insight into what our constituents are suffering from and their experiences.
There was a call in the debate for the best possible solutions. I would argue that we need a lot more diversity and that there is no one-size-fits-all solution. Diabetes is complex. A distinction has rightly been made between type 1, type 2 and juvenile diabetes, and while I have not spent the time on it that others have, there is a medical case for making further divisions in diabetes, particularly within type 2, for reasons that I suspect we do not fully understand.
On prevention, if I could have talked to my younger self and continued to exercise through my late 20s and 30s as I had as a child, I would perhaps not have the problems I have now. My diabetes is very much under control, and I praise the work of diabetes nurses around the UK, who have a little more time than the doctors and can coach people and point them in the right direction. For example, they mentioned a book to me, “Carbs & Cals”, which has pictures of typical meals and typical sizes and goes through the grams of carbs and the calorie intake—exactly like the type of poster that my hon. Friend the Member for South West Bedfordshire (Andrew Selous) wanted to see in doctors’ surgeries.
We should have diversity because some things have worked for me and some things have not. The shock of being diagnosed as diabetic made me change my ways. For months I would not touch chocolate and I would have no carbohydrates whatsoever. I went on a course about diet for diabetics that took a slightly different approach, which I went on to adopt, counting carbs and managing things precisely. Personally, that did not work for me and abstinence from sugar or carbohydrates worked better, but maybe for others it is different.
Exercise, for me, has worked well. I am hoping to run the London marathon, but whenever I do something such as that I question it. If I speak to anyone who has run a marathon, they talk about the big meal beforehand and say, “Make sure you have plenty of carbs the night before—lots of pasta and so forth that will release slowly.” One of the benefits I find in doing that is that I understand a little more about how carbohydrates are broken down, not just theoretically, but personally, and how my body reacts to carbohydrates and sugar.
When I left the doctor’s surgery I had the prick test for glucose. I ended up having three different machines, one of which eventually linked up to my iPhone. I do not now need to do a prick test on a regular basis, but I find it useful as a way of understanding my short-term glucose as well as the six-monthly blood test that I do. Personally, as a type 2 diabetic, while I do not need to monitor my glucose on an hour-by-hour basis, I would find it useful to have something on me for a week so that I could see the effect of having a tiny bit of cereal this morning, or the difference in my glucose if I have had two glasses of wine the night before. What is the difference between running five miles and 10 miles? How many carbohydrates should I have to compensate? We need a lot more diversity in provision over time.
Having outed myself as a diabetic—as I said, one should not feel shame about it, but I did for quite a while—and spoken about it in the House of Commons, I hope that I, like a number of hon. Members, can be an advocate for diabetics across the country, understand not only my condition but those of others, and help to improve the situation over time. I thank my right hon. Friend the Member for South Holland and The Deepings for raising this incredibly important issue in the House.
It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing the debate, for his very knowledgeable introduction and for the consensual nature of the debate that has taken place.
We have had a number of contributions; I will just touch briefly on the main speakers. The right hon. Member for Knowsley (Mr Howarth) reminded us of the importance of recognising the two different types of diabetes, which cannot be emphasised enough. I was also interested in his comments on the artificial pancreas. The hon. Member for South West Bedfordshire (Andrew Selous) raised the risk of diabetes being normalised and the impact of obesity, and the food industry’s contribution to exacerbating the problem. The figures he quoted on sugar intakes were genuinely frightening and should be a lesson to us all. The hon. Member for Rochford and Southend East (James Duddridge) gave his personal experience of his diabetes being under control. The very interesting thought of what we would say to our younger selves is one that we need to take out to our constituents in order to make an impact on the problem.
Health, of course, is a devolved matter. Consequently, it seldom features in my casework as a Member of this Parliament. That said, many of my friends have diabetes, either type 1 or type 2. It is the fastest growing health threat of our time and a critical public health matter. Diabetes is increasing rapidly, and one in 20 people in Scotland are now diagnosed with the condition—I stress diagnosed, because there will be many others who are undiagnosed. The latest figures published by Diabetes UK show that more than 3.5 million people in the UK were living with a diagnosis of diabetes in 2016-17, with just less than 290,000 of them in Scotland. Diabetes UK also reported that if nothing changes, more than 5 million people in the UK will have it by 2025. That is a figure that a number of people have used, and it is worth repeating to emphasise the impact of this health crisis.
In the Forth Valley area, which covers part of my constituency, more than 14,500 people are currently living with diabetes and there are more than 9,000 people with diabetes in West Lothian, which covers the other part. That helps to put the issue into perspective across a number of constituencies.
It is estimated that more than one in 16 people across the UK has diabetes, either diagnosed or undiagnosed, and it is worth remembering that around 80% of diabetes complications are preventable. I believe that in Scotland around 10% of NHS spending goes on diabetes—I think the English figure is fairly similar. If 80% of that is preventable, then think how much we could save by tackling this problem, in addition to the benefit to people’s lifestyles that could be achieved. Many of those complications are preventable or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part.
When I last spoke about diabetes, a couple of year ago, we talked about technologies. I confess that at that time I had not really witnessed much of them first hand, so I was pleased over the festive break when I saw one of my friends, Paul Kingsley, who has lived with diabetes for some time. He has a Libre patch sensor and an insulin pump. He showed me how that worked, which was interesting to see. It has made a real change to his life. I can remember when he had to do the prick tests and take his needles with him everywhere he went. Technology is making a big difference to people’s lives.
With the challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes ever more important. There are 19,000 new cases of diabetes diagnosed every year in Scotland and numbers are set to increase year on year, particularly with rising levels of obesity. Early results from ongoing research, led by Mike Lean at the University of Glasgow and Roy Taylor at Newcastle University, showed that it is possible for some people to put their type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. I believe that, as a result of those promising results, NHS England has committed to piloting a remission programme for 5,000 people with type 2 diabetes in 2019, and the Scottish Government, through their “A Healthier Future” plan, pledged £42 million to the prevention, early detection and early intervention of type 2 diabetes. There is a lot we can learn from each other from these processes and as the results of these tests come out.
NHS boards in Scotland will be able use that funding to deliver programmes to prevent type 2 diabetes and to put it into remission. One such programme that receives funding from NHS Forth Valley is the Braveheart Association, a Scottish charitable incorporated organisation based at Falkirk Community Hospital. The Braveheart programmes have been designed to provide resources to support and improve the health and wellbeing of Falkirk communities. They create community-led activities and outreach health services to improve the health of local people. One of the initiatives is Braveheart Plus peer support groups, which focus on those living with type 2 diabetes and coronary heart disease. One beneficiary of Braveheart’s walking project is a lad called Ali, a sufferer of heart disease and diabetes, who was initially reluctant to take part. Through participation, he now leads his own bi-weekly group, enjoys meeting new people and is able to manage his health conditions much better.
There is little doubt that eating a poor diet and being overweight or obese causes serious health problems, such as type 2 diabetes, cancer and heart disease, and it is clear that we must take decisive action. The SNP has an ambition to halve childhood obesity in Scotland by 2030, which is one reason why the Scottish Government are consulting with the public, and food and retail industries on restricting in-store marketing and promotion of foods high in fat, sugar or salt, with little or no nutritional benefit. That is very important; I think we have all been tempted.
I fully agree; that would be very useful to have.
I think we have all been guilty of impulse purchases when out shopping. It is always worse if we shop when hungry and there is a temptation to get fast food and a quick fix. We are all more than capable of cooking good quality meals, but convenience and lifestyle often get in the way of that. There is a lot we could do if there was a better marketing regime. The consultation in Scotland is part of the diet and healthy weight delivery plan, which will inform an assessment of impact and possible legislation.
No debate these days can be complete without some reference to Brexit, and why should this one be any exception?
Break in Debate
It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.
We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.
This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.
We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.
We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about brine labelling to my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter, and to my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.
I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.
My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.
I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is it more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.
There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.
We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.
As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of conditions, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.
Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.
Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.
Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.
In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.
There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.
The reasons for health inequalities are complex, but obviously we encourage people to make the lifestyle changes that enable everyone to live longer. I simply do not accept that the direct causality that the hon. Lady has outlined is as clear as that. We will focus on programmes that help people to lead healthier lives with better diets; that tackle tobacco control; and that prevent diabetes.
My hon. Friend makes an excellent point. Clearly the more we can do to educate people to make informed choices to improve their diet, the better. He is absolutely right: poor health among children used to be indicated by being underweight, but now being overweight is very much an indicator. I congratulate any food manufacturer that is taking action to address the problem.
Public Health England is trialling PrEP, and I am willing to work with the hon. Gentleman and others to ensure that we do everything we can in this space. The truth is that outcomes are improving in many areas of sexual health, and we have to ensure that we get the right treatment to the right people at the right time.
I welcome the hon. Lady’s commitment to this area. Clearly it is very important to have the workforce in place. As she said, we are making progress, but we still have more to do. As far as the international approach is concerned, the response to the summit was that many countries came together, because collectively we all face the same sorts of challenges. I am in absolutely no doubt that the leadership shown by some countries, including the UK, is warmly welcomed.
My hon. Friend knows my personal strength of feeling about tackling the scourge of fixed odds betting terminals. The links between gambling addiction and mental health issues—and indeed, directly to suicide—are clear in the evidence, and we must address them.
I have seen that proposal from the Alzheimer’s Society and we are looking at it now. At the same time, we are working on both the Green Paper for the future of social care, which will come before the end of the year, and the long-term plan for the future of the NHS. The interaction between the two is important.
I will come on to the proposed funding reforms. My hon. Friend is right that there is support for reform across the House, but there is support for different types of reform in different parts of the House. I respect the shadow Opposition spokeswoman, but it would help if she could bring more clarity to the Opposition’s position, updating the proposal that they put forward in 2010, which I will come on to in some detail. That will help if they want to genuinely contribute to this debate.
Of course, social care is not only a challenge of old age. The number of people of working age with care needs is also growing. Many of us in this House will know the pain and difficulty of helping a loved one who needs constant care or faces dementia. Such pressures bring long-term challenges, and we must ensure that both the NHS and our social care system can respond to the challenges we face.
It is a pleasure to speak on this matter. I commend the hon. Member for Totnes (Dr Wollaston) for setting the scene, and the hon. Member for Stockton South (Dr Williams) for making such a valuable contribution. I do not have the expertise of those two hon. Members—far from it—but I have a deep interest in the health service, and the treatment and service that is provided, which is why I am here. I thank the hon. Member for Totnes and all those who made a contribution to the Health and Social Care Committee’s seventh report, “Integrated care: organisations, partnerships and systems”.
We are ever-mindful of the anniversary of our own NHS. A lot of minds have looked back over the past 70 years, and we have all looked back over the years that we have been here, and we are thankful for the institution, which has been a beacon of the best of British by far. Just last weekend, I was present as my local council, Ards and North Down Borough Council, conferred the freedom of the borough on the NHS as a gesture of good will and a vote of thanks to those who work so hard in adverse conditions to provide care to those we love. As an active representative, I speak to those who work in the NHS and are recipients of NHS services every week. The hon. Member for Totnes made many telling comments, but one that I took from the very beginning of her contribution was that the purpose is to deliver a better service for patients. That really is the core of what we are about in the NHS, and at the core of the report’s recommendations.
Until recent years I had little cause to visit doctors or use the NHS but, as often happens, with age came complications, and diabetes was one of those. The doctor then said, “You need a wee tablet for your blood pressure. Well, you don’t really need one, but we’ll give you one anyway, just to keep you right.” Along with that, last year I was in hospital on three occasions for surgical operations. Not having been there for more than 40 years, suddenly finding that I was almost a regular visitor to the hospital gave me a really good idea of what our NHS is like today. I put on record my thanks to all those who made valuable contributions to those operations. I know it was down to the skills of the doctors and surgeons, but it was also down to people’s prayers.
We all know that the NHS is hanging on by a thread in many cases. It sometimes seems like that, but when I hung in the balance the NHS rose to the challenge. Sometimes we think that the NHS cannot deliver, but very often it does, and it delivers well. Any discussion about the NHS must begin with thanks to those who make it work against all the odds and who make what should be impossible possible. All of us here—myself in particular—say, “Thank you.”
I thank every person involved in the report, and I thank the Minister who is here to respond to it; I know he will do so very positively. As I began to read the report, the massive amount of work that went into it became abundantly clear. We need to bring on board the people with the vision for the NHS, as put forward in the report. I can see the vision for the NHS—I can read it on paper anyway, and then picture it. I understand the rationale behind the vision, but I also see the fear of secret privatisation, which people believe to be taking place. Some of the hon. Members who intervened referred to that.
We have all seen what happens when things move from public to private, and people fear a lack of services. That is easy to understand when talking about the loss of a rural bus link, but not when discussing whether a mother who is 72 years of age and has cancer will get treatment on the NHS. There is a fear among the general public that risk assessments will mean that we do not give such people a chance. I know that that is not the case, but we have to consider public opinion, and how people assess and see the situation. People see things quite simply at times. It is good to see things simply, because it makes it easy to follow through with the solution—those are my feelings anyway.
My feeling is that something has to change in the NHS. We all understand that bandages are not enough—it needs clinical surgery and massive intervention, some elements of which are in the recommendations. However, in order to be able to do that, we need to first prep the patients—the general public. We need to convince them that the proposed changes are for the better. We need to do a better job of preparing the public and explaining exactly what the plans are.
As the report was at pains to show, people do not fully understand how the NHS works. Information is not shared between emergency services and GPs in the detail and with the connections that it should be, and healthcare is provided from different sections who are not working together as well as they should. The integration referred to in the report can only work through partnerships that are truly trying to work together. When there is no understanding there is fear, and while people may not understand the current system, by and large they trust it. They trust that when they dial 999, an ambulance will arrive and bring them for care to their local emergency unit. When we tell them things are changing and we abbreviate terms using initials that save time but increase complexity, they fear that the very thing that they can trust no longer exists, because it is different from what it was five or 10 years ago, and they do not quite understand what is being said. That is why it is important to keep it simple. Of course, however we change the NHS, an ambulance will always be sent in response to a 999 call, but the simple fact is that people do not trust to that, so they will be unsure about what will unfold.
As a lay person, without the expertise that many on the Committee have—I bow to their knowledge and expertise—it is my humble opinion that we must do better in informing people how things are working now and how they can improve with changes, but understanding takes time and it is better to bring the public along, clarify uncertainties and address the issues at an early stage. Such corrective surgery has to take place, but the theatre must be prepped. People must be allowed to understand and that has to come with co-ordination and better working relationships with the press, as well as one-on-one discussions with patients when possible. It must happen with easy-to-understand information and it must happen before the changes are implemented.
I congratulate the hon. Members involved in preparing the report. I look forward to the Minister’s response, as well as the contribution of the shadow Minister.
I, too, welcome the opening speech of the hon. Member for Totnes (Dr Wollaston), who is a superb Chair of the Committee. The marketisation in NHS England goes back more than 30 years—it has certainly been happening for most of my career. It started with terms such as “resource management”, and in 1990 the internal market—the purchaser-provider split—was introduced. In the early 2000s under Labour, private companies started to introduce independent treatment centres. The Health and Social Care Act 2012 turned it into a massive external market and created the pressure to put all possible contracts out to tender.
The problems are well known. If we base a system on competition and not on collaboration, we inevitably create fragmentation and destroy integration. That has broken up patient pathways and made the system very confusing, to the point that CCGs were looking to employ what they called primary providers, which would have been another layer of cost and health organisation, to try to join things up for patients. Thankfully that has been shelved, because there is a sense of going in a different direction, but up to now there has been a repeated sense that everything can be solved through a healthcare market. That is why, in Scotland, we have grave concerns. One of the 24 powers coming to Scotland is power over public procurement—we do not see the market as the solution to everything.
Just five years on from the actual on-the-ground changes of the Health and Social Care Act, NHS England is facing another big reorganisation. As other Members said, unfortunately the rushed sustainability and transformation plans and the lack of consultation with both the public and staff has created anxiety and fear. As is now recognised, the term “accountable care organisations”, which was copied from the American system, was a PR mistake of the highest order.
In 1999 in Scotland—after devolution—we simply went in a different direction. We merged trusts and then abolished them in 2004. We got rid of primary care trusts in about 2009. We already had an area-based health service for the entire population—not just for people registered with their GP—based on per-capita funding. That meant that we could start to look at how to integrate acute hospitals with community hospitals and even local village hospitals for step up and step down—not everyone who is unwell and cannot be at home needs to be in some big, shiny 10-storey block, and might just need a bit of extra care for a few days, so there is an argument for community hospitals.
In 2014, we started looking at integrating health and social care. Because of the fragmentation in NHS England, it will be necessary to integrate health first, and then integrate social care. Integrating social care is much more challenging because it is made up of different players in the market and is done in a different way. As the hon. Member for Totnes pointed out, the overarching difference between free healthcare and means-tested social care creates major challenges.
It is not a particularly formal term. I simply mean that there has been a tendency to think that, because community hospitals cannot provide the full range of acute healthcare, they have no place, whereas someone might require only a low-level of in-patient care, such as an elderly person who has a urine infection and lives on their own may need intravenous antibiotics, fluids or extra care. Such hospitals allow us to have much more healthcare—things such as minor injury units—close to the public. The more we take forward to people, the less worried they will be about the fact that we are coalescing specialist services. If they see services coming towards them, they will not have the sense that everything is being taken away. We have utterly failed to impress on the public that healthcare is not about buildings, but very much about people and services. That is what integrated care should be about.
I do give credit to the Government for making investments in this area of provision. We started from quite a low baseline. There has been significant investment. Too many women are still missing out on these specialist services; the coverage throughout the country is patchy, but I acknowledge that things are improving. However, if we are not identifying half the women with perinatal mental health problems, that is a significant problem in itself.
The investment required to identify problems through the six-week check is estimated by the NCT to be about £20 million a year. That is a very small amount in the grand scheme of the NHS’s budget, but it could make a huge difference to many new mothers. Secondly, in addition to the funding for the six-week check, the NCT recommends improved guidance for GPs on best practice on mental health, specifying a separate appointment for the maternal six-week check and the best methods of encouraging disclosure of maternal mental health problems.
A separate check involving supportive, open and encouraging questioning would provide an opportunity for women to come forward with any problem that they may be having. It might also help to eliminate some of the feelings of stigma or shame; 60% of women said that they felt embarrassed, ashamed or worried about being judged. Just because it is in a GP’s contract does not mean that a doctor has to do the work; with the right training in place, it can just as effectively be undertaken by a practice nurse or other suitably qualified healthcare professional. What is important is that it forms part of the ongoing relationship that a new mother has with her GP practice.
The third NCT recommendation covers NHS investment in and facilitation of GP education. It is important that GPs are trained to recognise the symptoms of post-natal depression and differentiate them from “the baby blues”, which resolve on their own; and it is crucial that mothers are reassured and valued, not dismissed.
These three relatively straightforward measures—a contractual obligation, guidance, and training—could make a huge difference to many women’s and children’s lives. They could eliminate some of the preventable problems encountered by women suffering from perinatal mental illness. The average cost to society of one case of perinatal depression is estimated at £74,000. With an already overstretched NHS under immense pressure, these measures could alleviate some of the stresses placed, later, on mental health services; they will inevitably have to deal with the consequences of undiagnosed and untreated perinatal mental health problems.
With this debate, we are already raising awareness and challenging some of the stigma surrounding perinatal mental health, but we also have a unique opportunity to do something practical to address the problem. Negotiations for the new GP contract begin in September, and by holding this debate today, we want to gain wider support for these important recommendations to be included in the new contract.
There are many other areas of perinatal mental health that I hope we get the chance to explore in this debate. We have already discussed the availability of specialist perinatal mental health services. I hope that we also talk about the variable access to psychological therapies, which are excellent in some parts of the country; in other parts of the country, women struggle to access those services, too. I am very grateful to the other hon. Members who have come today to speak and contribute.
I consider myself to be a fortunate father, one whose experience of parenting has so far been very positive. Many parents are not so lucky. When I hear the heartbreaking stories of women whose post-natal depression has blighted their and their family’s experience of parenthood, I am reminded of just how fortunate I have been. I am also acutely aware of how damaging it will be to wider society over the longer term if we do not improve the way in which we handle this issue. We need to bring the hidden half of these women out of hiding. Post-natal mental illness is not just a problem for new mums. If we fail to tackle it, we risk failing the next generation of children, too.
It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), and I thank the hon. Member for Stockton South (Dr Williams) for setting the scene so well. He obviously has a passion and a knowledge of the subject—not just as a father, but from his previous job. I have a knowledge of it through people who work for me and who I have social involvement with, including the lady who writes all my speeches—she is a very busy girl—who always wanted to be a mother and had two miscarriages. I am very conscious of her story, and I will tell that today.
The wife of my hon. Friend the Member for Belfast East (Gavin Robinson), Lindsay Robinson, who set up a charitable group in Northern Ireland, has also given me permission to tell her story, which I will do in the way she told it to me. It is important to record those stories. We have come together on a Thursday afternoon to tell the story of why perinatal illness is very real, and to think about how we can help, which is the real reason for being here. I always say that we try to provide solutions so we can do things better. For the record, I should say that I have already apologised to the Minister and the shadow Minister, and to you, Mr Davies, for having to leave early, because I am committed to a later debate.
The work of the NCT is vital and a great support to parents all over the world. In Northern Ireland, we have three active branches that offer local mums, dads and families vital information, resources, connection points, community and friendship when they need it most. I thank the charity for the time and energy it has put into the research for the #HiddenHalf campaign, which has focused our attention on the issue of maternal mental health. It is clear from its work, and that of all those in the maternal mental health arena, that too many women go undiagnosed and unsupported. This debate must be a way to address those issues verbally, and we look forward to the Minister’s response about how she will help us.
NCT’s #HiddenHalf statistic that the problems of almost 50% of women who were surveyed, and who struggled, were not identified by a healthcare professional and that they did not receive any help or treatment is shocking. We must work together to change that. All the hon. Members who have spoken so far have reiterated that point.
My parliamentary aide, Naomi Armstrong-Cotter, who is also a local councillor, has spoken out in a personal way about her experience of miscarriage, of successful pregnancies afterwards, and of the fact that a leaflet handed to someone is not enough to give them the tools to deal with the emptiness of that loss. Our local paper, the Newtownards Chronicle, gave her an opportunity to tell that story; coincidentally, that appeared last week. Her plea was for greater support during and after pregnancy; for a network whereby someone did not have to search for help, but it was ready and waiting; and for follow-ups to be given more effectively. She is now blessed by God with two children, and I have no doubt that her family’s support kept her life together when she was having great difficulty trying to adjust to what was happening to her.
My party fully supports the #HiddenHalf campaign and I attended an excellent event in Parliament two weeks ago to raise awareness of its work on the issue, where I heard stories from mums whose lives have been marked by the illness and by not receiving the timely help that was necessary to make a difference. The event was hosted by my hon. Friend the Member for Belfast East, who understands only too well the devastating impact that maternal mental illness can have on women and the wider family unit. He was the other half who lived with the difficulties that his wife Lindsay was having. She struggled and suffered for two years before getting help. She has given me express permission to use her experience in this place to highlight the failings and the need for a brighter future.
From her experience, Lindsay spearheads the campaign in Northern Ireland for mums, dads and their families to get the support they need and deserve via her movement, “Have you seen that girl?” At the event that I and others attended, the impact of the NCT NI volunteers was clear. She also plays a role in the Maternal Mental Health Alliance’s Everyone’s Business campaign, of which NCT is also a part. Many charities and bodies have come together to offer support.
From the point of view of the two ladies whom I have referred to—my permanent parliamentary assistant and speechwriter and the wife of my hon. Friend the Member for Belfast East—the Church has also helped. It is important to have a faith and to have access to that at an important time.
Having met Lindsay—I spoke to her this morning, just before she left here—I understand that 80% of Northern Ireland still does not have access to specialist perinatal mental health services and that funded community-based peer support is limited. I understand that the Minister is not responsible for Northern Ireland, but from a Northern Ireland perspective, unfortunately, I would be surprised if we were not behind the rest of the UK, which is not good. We need to be up alongside and equal to other countries across the United Kingdom, as the hon. Member for South West Bedfordshire said, but treatment and support is a postcode lottery with too many mums and families being let down when they are at their most vulnerable.
The campaign for change is based on three areas. There should be provision of a mother and baby unit. Unlike in England, Scotland and Wales, a mother and baby unit is not available in Northern Ireland, which is disappointing—nor is it on the whole island of Ireland. The Minister is not responsible for that either, but it shows hon. Members that across north and south Ireland, we have not moved to make that happen. That means that mum and baby have to be separated should in-patient treatment be required. That is a very negative thing. I want to give a perspective on where we are in Northern Ireland and also say what has happened there recently. Some headway has been made—not enough, I have to say, but some at least.
The situation is simply not good enough and can have further negative effects on the mum and the family. There are five health trusts in Northern Ireland, but such specialist services for mothers are currently only available in one: the Belfast Health and Social Care Trust. Although that trust’s services are fantastic, they cannot meet the needs of the whole population of Northern Ireland; that would be impossible for one trust. Mums and families outside the Belfast trust’s area also deserve access to specially designed care and support.
Community-based peer support is also important. I am informed that currently great support is provided in the community and in the voluntary sector, often by mums themselves. How often do mums all come together to support each other? My wife had great support when we had our children; that was not only family support but support from other mothers who had had children at the same time. Again, however, in Northern Ireland we are without proper funding to successfully grow that kind of work.
I make a plea. I am aware of the NCT’s Parents in Mind programme, which is running very successfully here in England—on the mainland—and doing tremendous work. MPs from the mainland will know that and welcome it. NCT Northern Ireland volunteers are keen to source funding to bring that programme, or a similar one, to parents in Northern Ireland. We look forward to the day when that happens. For many parents, peer support is a lifeline, offered by those mothers who have faced a similar battle and who are keen to receive training so that they can provide help to others.
I am also aware from my party colleagues in Northern Ireland that Lindsay Robinson and Tom McEneaney, working with the Maternal Mental Health Alliance, led a team of campaigners to meet the all-party working group on mental health at Stormont; although Stormont and the Northern Ireland Assembly are still not functioning as they should, meetings still take place. The campaigners presented the information and asked all the Northern Ireland parties to sign a consensus statement, pledging their commitment to action all of the issues that I have mentioned as soon as possible. I am delighted that my party—the Democratic Unionist party, for which I am the health spokesman—has signed up to that, and I am assured that other parties have also signed up to it. We are keen to meet further with the team and give them our support. I hope that we are considering a strategy that will take us right through the next period, hopefully with a functioning Assembly. However, the strategy will certainly work, whether or not the Assembly is up and running.
I will close now, Mr Davies; I am always very conscious that there are other speakers to come. In closing, I again offer my full support to the NCT’s #HiddenHalf campaign and its goals here in England—on the mainland—and I thank the NCT for its continued support for the campaign in Northern Ireland. The NCT is supporting our campaign in Northern Ireland and we thank it for that, because it is very important that we have that support. As I have said often, we are better together—the United Kingdom of Great Britain and Northern Ireland—with all regions working on things that are of mutual interest to us all. I understand that the NCT is fully behind all that is happening and will become further involved in the coming months, and I look forward to that.
Also, I commend Lindsay Robinson and all those who have been campaigning in Northern Ireland for improvements to maternal mental health. We know that they are making a difference, both to the parents in their communities and also with decision makers. However, we must also take action in this House. We must do what we can to honour the bravery of those who lay their experience on the line for people to see and bring about changes that support mothers and families across the UK.
Again, I congratulate the hon. Member for Stockton South on securing this debate and other Members who have spoken or who will speak; I look forward to hearing all the contributions to the debate.
It is a pleasure to serve under your chairship, Mr Davies, and I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this debate.
We should judge the success of our society by how we treat our new mothers—it really is that simple. I am here today to speak up for better-quality, more consistent and well-funded services for perinatal women.
I am not a new mother. In fact, my youngest teenage son is sitting just over there in the Public Gallery and Members may be able to tell from his towering 6-foot frame just how long it has been since I was recovering from giving birth to him, the second of my two gigantic children. Even so, I remember those special early days for all the many wonderful, and some horrible, reasons that all mothers will know.
We do not discuss post-natal truths enough in the UK. Women will sometimes share with their friends the gory details of their experience of giving birth, but we rarely ever see in the print media, on TV, or in films what happens after a baby is born. If the fairy tale does not end when Cinderella weds her prince, as most fairy tales do, it most certainly has ended by the time Cinderella has entered her third trimester and is waddling around the palace. Nobody wants to hear about Cinderella’s third-degree tear, the fact that her boobs leak, the possibility that she may experience incontinence, or the fact that, even though she has a wonderful, healthy baby in her arms, she just cannot stop crying. But fairy tales are out of date and so is the fact that we do not talk about perinatal experiences—both external and internal experiences—with the honesty we need.
Things are changing, however. After all, we are here today saying that what is on offer to post-partum women in the UK just is not good enough. It is outrageous that women in one quarter of the UK are still without access to specialist perinatal mental health services. How can the mental healthcare of new mothers still be a postcode lottery? It is not as if mental health changes are uncommon after a woman has given birth. In fact, 81% of women say they have experienced at least one perinatal mental health condition either during or after their pregnancy.
I know from talking to friends, family and, indeed, constituents how imperative perinatal mental health support is. We must remember that three quarters of women who say they have experienced a perinatal mental health condition had no previous history of mental health problems. For those who have experienced mental health problems before giving birth, changes to the brain’s chemistry post-birth, combined with post-partum isolation, can trigger the return of symptoms that they had previously experienced, often in their teenage years.
Speedy referrals and access to early treatment is vital for those who experience mental health issues during or after pregnancy. What is so worrying is that it takes more than four weeks for 38% of women in the UK who are referred to be seen. In fact, there are cases of women suffering post-partum who have the courage to seek help from their doctors and health visiting teams but who still have to wait beyond a year for help after referral. That is a whole year that these women are waiting for help in what is often one of the most turbulent, joyous, change-filled and complicated times in any mother’s life. Any service that keeps people waiting for more weeks that I can count on the fingers of one hand is completely unfit for purpose.
We must close the funding gaps that cause huge waits—it is reassuring to hear that the Government intend to do that—and end omissions in service provision. We must also ensure that maternity services do not remain overstretched and understaffed. We must bring back full bursaries for midwives and related healthcare qualifications, which will allow staffing gaps to be filled with the much-needed new caring talent that will have the capacity to offer continuity of care to high-risk women in pre and post-natal moments of vulnerability. The erosion of higher education bursaries, especially for nurses, midwives and other healthcare students, was yet another example of this Government knowing the cost of everything but the value of nothing.
There is another reason why we must act and act soon. A study by the department of anthropology at the University of Kent, which is in my constituency, shows that post-partum depression discourages mothers from having more than two children. The decision to have children, or the decision to have more children, is a woman’s choice alone. However, that choice must be made without the pressures and limitations that come with poor funding of post-natal care. A choice made through fear is no free choice at all.
I completely echo colleagues’ calls for there to be much greater depth in the maternal six-week check. The baby’s check by the doctor and the mother’s check by her doctor must be separate. A woman’s six-week check cannot be limited, as I so often hear it is, to a few rushed questions. I have been told of women being asked only about the contraception they plan to use, with no questions at all about their physical or mental wellbeing. I have heard from friends that their doctors simply asked them, “Are you feeling okay?” That is not a proper question. As any mother will say, the moment their new new-born is in their arms, the definition of what was previously considered “okay” is thrown of out the window. Time must be put aside for proper, in-depth questions and for real insight.
After all, as we have already heard, according to the Royal College of Midwives 42% of women with post-natal depression never even mention it to a healthcare professional, and three quarters of those women stay quiet because they feel guilty about having such thoughts. Moreover, many women are led to believe that serious mental health issues are merely a bout of the baby blues. We urgently need proper training and proper conversations to create an environment where mothers feel safe, well-informed and able to talk about any difficult experiences.
I acknowledge that even the most thorough six-week check for women would not always pick up on everything. Post-natal depression can sometimes manifest slowly. One study suggested that the majority of women experiencing symptoms did not report them until six months post-partum or later. To tackle that, I urge that the maternal mental health check by health visitors at three to four months is reinstated. Even taking more time at that early point when a woman is sat with her GP at the six-week check will save lives. A couple of weeks ago, I attended the NCT’s #HiddenHalf event, where several brave women attested to just that.
I thank the hon. Gentleman for that intervention. I have not looked at the issue in that kind of depth. I have been working on it with local women and local groups who suggest that it would be good to reinstate it. I will look into it further.
The women at the #HiddenHalf campaign event said that their lives had been saved by a fortuitous visit to the right GP at the right time, but they know they were the lucky ones. The mother’s six-week check must also allow time for a full physical health check to prevent long-term and often totally avoidable health complications resulting from difficult deliveries. Furthermore, it is my belief that a course of pelvic floor physio should be provided for every single woman who has experienced a vaginal birth, as happens in France. I am working with a group of women on health policy for post-partum women. This debate focuses on the perinatal health symptoms of the hidden half, but many of the mental health conditions that health visitors report are triggered by the physical trauma of a difficult birth and women having to reconcile themselves to a completely new sort of body.
Those of us here today will not stop campaigning and raising the issue until the situation changes for new mothers and new families who need our help. We should get the full truth of post-natal motherhood out there and become a country that can rightly say, “There’s lots of help here for you. We will assist you and your families for as long as it takes. We are here to champion and celebrate you in being the happy, healthy, supported mother that you ought to be able to be.”
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The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.
I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.
I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.
That sounds like a good resource, not least because it means women can get access to help in a more anonymous, less threatening way. We need sufficient tools to be available for women—and families, for that matter.
We have heard constantly throughout the debate that women are not always asked about their mental health in GP health checks. For that matter, they are not always asked about their physical health either; it is all about the baby. One of the challenges we have in improving the way in which we deliver health comes from the fact that an NHS practitioner faced with a patient will focus on the immediate problem and not the patient’s holistic needs. There is a need to consider mother and baby together. A baby cannot be looked at in isolation. The role of the mother, and the relationship with the mother, is part of the child’s welfare. We need to spread better practice in that regard.
I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.
Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.
I completely agree. If we are still talking about this in two or three years’ time we will have failed. We have to get some decisions and get on with it. As politicians, we are often very good at coming up with ways to spend money. In this report we have actually come up with ways to raise money, which is the difficult part. We have done the heavy lifting for both the Government and the Opposition Front Benches. We now say, “We’ve handed the pass over to you. Get on and run with it and make it work.”
There is no mention of breastfeeding in the plan, but that does not mean that I and my colleagues do not see it as a very important part of the early years programme. In areas that I represent, as well as, I am sure, in other areas represented by colleagues, local authorities are often actively engaged in making sure that breastfeeding is a very important part of a child’s start in life.
As my hon. Friend will remember from my speaking to the Health Committee, I have also been to Amsterdam, but unfortunately not for as long as the Committee members were. The whole-systems approach taken by Mayor van der Burg and Amsterdam is very impressive and has resulted in a 13% reduction in child obesity. Local authorities can learn from their attempts to market their cities, areas and regions, and I would suggest that having a good, healthy community and a good, healthy look when people walk out of the airport and do not see massive adverts for unhealthy fast food is an important part of that.
I thank the hon. Lady for her intervention. Merryn’s is not an isolated case, and neither are those of my constituents—I am sure that Members present have all heard constituents describe the same situation.
The PACE trial, which recommended CBT and GET, influences how health insurers and the DWP make their decisions. Insurance companies refuse to pay out unless a programme of GET has been undertaken, and many people who apply for benefits are told that they must carry out GET—or, indeed, that they appear well enough to work. PACE is unique in UK medical history, in that it was part-funded by the DWP. The links of some of its main authors to health insurance companies are troubling. One of those authors, Professor Michael Sharpe, states in his briefing for the debate:
“Several of the investigators had done small amounts of independent consultancy for insurance companies, but this was not relevant to the trial. The insurance companies played no part in the trial.”
I will leave hon. Members to make up their own minds about that.
Healthcare professionals worldwide are starting to take note. The US Centres for Disease Control and Prevention and the Health Council of the Netherlands have both abandoned GET. If those countries acknowledge the flaws of GET, why are ME sufferers in the UK having to fight so hard for similar acknowledgement? The ME community hopes that GET will not feature in the NICE guidelines for ME treatment after they are revised.
Some argue that CBT is provided as a treatment for many illnesses, including heart disease and cancer, and that ME patients’ rejection of it is irrational. The key difference is that cancer patients receive biomedical treatment in addition to CBT, rather than having CBT to the exclusion of biomedical interventions. Biomedical treatment for ME is woefully lacking. There are reports from the US that certain antiviral drugs improve the condition, but without properly funded research to identify biomarkers for ME, we do not have the answers.
Diagnosis is currently based on a patient presenting with known symptoms. Although there is no biomarker for ME, that does not mean there is no biomedical test for it. The two-day cardiopulmonary exercise test, which can objectively document the effects of exercise, could be used as a diagnostic tool. In simple terms, people with ME perform adequately or even well on the first day but have reduced heart and lung function on the second. That relates to the point made by the hon. Member for Alyn and Deeside (Mark Tami) about the DWP and the fact that someone’s presentation may be good one day but not the next.
That protocol involves two identical tests separated by 24 hours, the collection of gas exchange data and the use of an exercise bike to measure work output accurately. That type of testing reveals a significant performance decrease on day two among people with ME, in terms of their workload and the volume of oxygen they consume before and during exercise. Results from a single test may be interpreted as deconditioning, which may lead to harmful exercise being prescribed. However, the objective measurements of the two-day test remove the issues of self-reporting bias and the question of effort—in other words, the results cannot be faked.
Those results support the strong and consistent patient evidence of the harm that can occur as a result of inappropriate exercise programmes. However, there are moves afoot to categorise ME as a psychological condition. NHS guidelines on medically unexplained symptoms class ME as such a condition. The Royal College of Psychiatrists states:
“Medically unexplained symptoms are ‘persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology.’”
I thank the hon. Gentleman for his intervention. Worryingly, the WHO is looking at reclassifying ME, too—we should all be aware of that—and its current classification of ME as a neurological condition has been ignored in terms of the treatment we have offered to patients here in the UK.
The Royal College of Psychiatrists goes on to state that symptoms are
“not due to a physical illness in the body. However, they can be explained, but to do this, we need to think about causes that are not just physical.”
Under the new “Improving Access to Psychological Therapies” guidance for people with long-term conditions, patients who present with ME are classified as people with medically unexplained symptoms who should undergo CBT therapy, in conjunction with other treatments—in other words, graded exercise therapy. However, as ME is classified as a psychological condition, patients risk getting trapped in the psychological care pathway.
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I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing the debate and all hon. Members who will participate in it. It is essential that we speak for the millions missing, and it is great to see so many people in the Public Gallery.
What I find so shocking is that scientists seem not to want to have the debate. I hope that right hon. and hon. Members across the House find it shocking that the hon. Member for Glasgow North West was written to by a scientist and called out. I have seen scientists writing in journals such as the Journal of Health Psychology calling out the PACE trial, so the idea that the scientists who produced that work have gone unchallenged by other scientists is simply not true. A huge amount of evidence from eminent people in the science community questions the PACE trials, including the methodology, the evidence they used and how they treated their patients, as the hon. Lady said. Therefore, it has been proven not to be the case that the NICE guidelines, built on that questionable evidence, are the only way in which we should consider this disease, and she did that well in a previous debate.
It is great that the NICE guidelines are to be reviewed, but my concern is that that will take some time. I am sure that is the right process; we must get it right and ensure that the voices of ME sufferers are heard. Scoping working groups have been set up in which ME sufferers have been able to participate, and that is welcome. But I find it quite scary that the current guidelines will be in place until October 2020. I have listened to my constituents and read about those of other right hon. and hon. Members who feel that if they are prescribed according to those guidelines and go through all that, it makes them more ill. Far from helping them, it makes them deteriorate. Indeed, I have a constituent who feels that the programme she was put through set her back two or three years.
Real harm is being caused by some of the therapies recommended in the guidelines. If that is the evidence from ME sufferers—I am not a scientist, but from what I have read, that experience is widely shared—it is up to the Minister, working with the chief medical officer and others, to question whether the NICE guidelines should be suspended, at least with respect to GET. If GPs, perhaps because they have not been trained, are making medical prescriptions for treatment following NICE guidelines because Ministers and the chief medical officer have not acted, if that treatment is harming people, and if that continues until October 2020 there will, as I said in my intervention, be a case for those who are harmed to go to court and seek compensation.
No one wants that. To avoid it, surely there must be a way in which Government Ministers, working with NICE and the CMO, can issue guidelines directly to GPs and medical professionals to say, “Be careful before you prescribe GET. Ensure that you have read the evidence. Ensure that you have talked properly to the patient.” With many drugs and pharmaceuticals, there are sometimes side effects. Therapy does not work for everybody. Where is the warning in the NICE guidelines of the side effects of GET? That is serious, because people could be seriously hurt in the period between now and the conclusion of the NICE review.
I will move on to research. Looking at the work that Invest in ME Research has done, for example, setting out the calls for research in this country over two decades or more, I find it quite disturbing that those calls have been ignored. Only charities have enabled a meagre amount of research to be done. Some £5 million was set aside for the PACE trial; if we could have a small amount of that money to start real, biomedical research into ME, we would be making a step forward.
I share the hon. Gentleman’s concern. I should say that we still need a lot of research into MS, so it is not one or the other, but given the incidence of ME, as he rightly says, the case for research into the biomedical aspects is strong. Invest in ME Research makes a number of proposals in its recent report. For example, it proposes a ring-fenced fund of £20 million a year for the next five years for biomedical research. That recommendation comes from a detailed report; it is not just plucked out of the air. That sort of figure would show that the Government mean business.
I am aware that Ministers cannot stand up at the Dispatch Box and say, “Yes, of course we will direct research money into this probe; I myself will do it.” I am not suggesting the Minister can do that today. I know he cannot. He has to work with research councils and others to direct the research. I am also aware that if researchers do not make proposals, sometimes research moneys cannot be granted.
That is the big question we have to answer for both the House and the British people. However, I would say to the hon. Lady that I am confident that, where there is unsafe practice, it is surfaced much more quickly now in the NHS than it has been in the past. I am less confident about whether we have removed the bureaucratic obstacles that mean the processes of doing such investigations are not delayed inordinately so that the broader lessons that need to be learned can be learned.
I thank my hon. Friend for his championing of the GIRFT programme, which is incredibly powerful and successful. He will have noticed that we announced last week that we are expanding it into a national clinical information programme, which will cover more than 70% of consultants. What is disturbing in this case, though, if I may say so, is that the data was really around mortality, and we have actually had that data for this whole period. There is really nothing to stop anyone looking at data, and we can see a spike in the mortality rates in this hospital between 1997 and 2001. They go down dramatically in 2001, when the practices around opiates were changed. That is why we have to ask ourselves the very difficult question about why no one looked at that data or, if they did, why no one did anything about it.
I would be delighted to look at the progress being made in Grampian, and we are always keen to learn from the experiences of other nations. The right hon. Gentleman makes an excellent point: people with long-term physical conditions are more likely to suffer from mental ill health. As for NHS spending, at least £1 in every eight that is spent on long-term conditions is linked to poor mental health and wellbeing spend. We have also produced a pathway for people with long-term physical health conditions to deliver more effective IAPT—increasing access to psychological therapy—services for them. However, we can always continue to learn about this subject.
My hon. Friend is right that once children become obese they are going to become obese adults, with all the health problems that come with that. I do not want to steal the thunder of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), but rest assured that we will examine what more we can do to tackle obesity in children.
In fact, the royal commission did cover funding. Over the last 20 years and more, I have spoken to many audiences, and have asked them, “What would you prefer—to have your house taken away from you, or Granny’s house taken away, or to pay slightly more tax?” The unanimous view was in favour of a slightly increased level of taxation to pay for long-term care. Everyone is going to get old. I am easily the oldest person in the Chamber. I am not planning to go into long-term care any time soon, but on the other hand I am closer to it than the other Members who are present. However, I will not speak about myself.
There is another factor in all this. In my constituency, there were three local authority care homes where the residents were happy, the staff were wonderful, and the healthcare professionals treasured them. All those homes were closed, and the land was sold off. Now we see the private care sector in constant difficulty. Given the collapse of Southern Cross and the ongoing threats to the future of many more homes, I believe that at some point the state will have to step in to ensure that care continues to be provided. Indeed, the Minister conceded that point: she said that we would have to step in and solve the problem. Why not set up a national care service now, and start to bring care homes back into the public sector as we did in 1948? I am not old enough to remember Nye Bevan’s speech in the House in which he proposed the establishment of the national health service, but I was inspired by him when I was at school, and my policies developed as a result.
Another scandal has been reported recently, namely the practice of effectively using self-funders to subsidise publicly funded residential care. Contracts with cash-strapped councils are squeezed, and charges for self-funders are increased to compensate. In one case, the charge for a care home resident who had been state-funded and then became self-funding was multiplied by several times. Most worryingly, there have been reports of inadequate care in homes across the country, which was mentioned by my hon. Friend the Member for Worsley and Eccles South. When care is provided by homes in the private sector that are squeezed for funding and have to make profits, it is inevitable that care standards will eventually be cut. It is clear that long-term care should not be in the profit-driven private sector, but should be a true public service, in the public sector. I commend today’s motion and all that has been said by many hon. Members on both sides of the House, but we have to move towards a national care service, based on exactly the same principles as the national health service.
Does my hon. Friend think that there is also a role for the greater use of co-operatives such as the CareShare organisation, which matches those in need of care with care givers so that they can swap time with each other?
It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), who is very knowledgeable on these issues.
In October last year, we sat in the Chamber and conducted an Opposition day debate on this crucial issue of social care. Today, six months later, we are doing exactly the same thing, not because there has been any major policy change or even any significant ideas from the Government, but because, six months on from the Government being told that there was a social care crisis, they have taken no concrete action to solve it. In fact, rather than tackle it head on, all they have done is shift the responsibility further on to hard-pressed councils and devolved the funding burden and pain on to individual taxpayers in my constituency and throughout England.
Social care faces a deficit of £2.5 billion by the end of the decade. That is not a Labour party figure, and it is not fake news; it is from the reputable King’s Fund. Cuts of £6.3 billion have been made to adult social care since 2010. As a result, there has been a 26% fall in the number of people accessing care, meaning that 400,000 fewer people are able to get the support they need and deserve.
My constituency of Weaver Vale is served by two councils: Halton, and Cheshire West and Chester. Both have fought a valiant battle against Tory austerity, doing all they can to protect the most vulnerable, but things are now at crisis point. Figures show that since 2011-12, external funding for Cheshire West and Chester Council and Houlton Council has been cut by 38.1% and 43.7% respectively. That situation is unsustainable. The care sector says so, the charities that support our vulnerable people say so, and even the Tory-led Local Government Association says so, yet still the Government do not listen. If they do not listen to the experts, or even to their own Tory councillors, perhaps they will listen to those at the sharp end on the frontline of social care: our staff.
On Saturday, I spoke to Paula, who represents thousands of local government workers in Unison in my constituency. She had a message for the Secretary of State:
“Do the right thing. Invest in our valuable public services. Invest in our amazing workers”.
This touches on some of the points made by Conservative Members. I agree with some of my hon. Friends who have said decent, quality social care costs money and that we need to put our money where our mouth is. We need to have an honest conversation about this. Let us finally take the bull by the horns and establish a national health and social care service. The Government must listen to public sector workers like Paula, and the millions of people like her, as well as to unions such as Unison. Only then will our communities and our councils have the funding that meets their needs, and which is stable and fair. Only then will we begin to tackle the crisis in social care.
I cannot disagree with such a well made point.
The impact of austerity has been a double-edged sword, according to the union Unison. On one hand, less money can be made from the NHS, so some firms have shrunk away. On the other hand, the NHS has opted increasingly for short-term fixes as it struggles with insufficient funding, and that has created opportunities for the private sector. For example, the Carter review includes the threat that hospitals that cannot make sufficient savings in their support services or pathology functions might have to use outsourcing instead. Most recently, the development of wholly owned subsidiary companies has brought a whole new set of fears for the NHS, and for health staff in particular.
The old fears from the 1980s and 1990s are beginning to resurface. When we add social care into the mix, those fears multiply. The NHS is one of our proudest achievements, and we need to protect it, not privatise it. To do so, we need to revoke section 75 of the Health and Social Care Act.
Equally, I have some information that was released to The Independent under a freedom of information request, which states that the Royal Marsden in London had an income from private patients in 2010-11 of £44.7 million. By 2016-17, that had risen to a massive £91.9 million—a rise of almost 105%. That clearly demonstrates that there has been a considerable rise in the private income of that world-leading NHS hospital.
It is a pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for introducing the petition and the petitioners for instigating a very worthwhile debate.
I will speak briefly, because I know that many Members want to speak, about fragmentation, accountability, privatisation, and how the NHS in Lancashire is going backwards. We will hear from across the United Kingdom —or certainly England—about the fragmentation of the NHS. It is not providing the services that patients expect.
The Health and Social Care Act was introduced in 2012. It was a top-down reorganisation, although it was promised that it would not be, that cost £3 billion and has caused chaos in Lancashire. That was a promise made by David Cameron that he broke. It has fragmented the NHS: we have lost accountability, we have opened the door to privatisation and we have reintroduced the purchaser-provider competition, which has been mentioned. In the 1990s, that was implemented in social care—it failed, and there was a U-turn.
In Lancashire, we have the high-profile case of Virgin Care’s £104 million contract signed by the Conservative Lancashire County Council, which has been blocked by a High Court judge for reasons of “considerable cost and disruption.” We are seeing the fragmentation of our NHS through the desire to privatise and move towards the purchaser-provider model. There has also been the removal of the Lancashire Care NHS Foundation Trust from Calderstones. The trust has been involved in taking up contracts and being relieved of contracts. The Walton jail mental health service unit is in crisis. It is an important service because we are trying to tackle the issue of mental ill health, yet there is a significant problem at Walton jail. Lancashire Care NHS Foundation Trust picked up the contract from somebody else, but it is struggling; it is underfunded, and the provider keeps changing. That fragmentation is having an impact on those who require these services.
At Calderstones, there was a very large mental health unit on the fringes of my constituency—in fact, it was just inside the constituency of the hon. Member for Ribble Valley (Mr Evans). The unit was rebuilt in 2007, costing £11 million, to provide a cutting-edge mental health service. It was rated “good” by the Care Quality Commission, but it was closed in 2016. How can the £11 million Calderstones unit, which was rated good and moving towards outstanding, be closed in this age and only nine years after that refurbishment? Calderstones Partnership NHS Foundation Trust itself will cease to exist, to be replaced by the Mersey Care NHS Foundation Trust, which will provide services. One service provider is being swapped for another. We are not getting continuity, and there are problems in NHS services, particularly mental health services, in my area.
The public want to say no to the Health and Social Care Act—they do not like these changes. GPs were told that they would hold budgets; I will come to that, but first I want to talk briefly about STPs. Again, there is little democratic involvement; the changes are being ushered in across the north-west and across Lancashire.
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As a union leader who spent 20 years working in the NHS, I certainly spoke up for all my members, who were deeply concerned about the destruction of the NHS because of the privatisation and fragmentation that was happening across it.
The second issue is what is happening to NHS buildings. We know that buildings were moved into NHS Property Services, which is a wholly owned company with one shareholder: the Secretary of State. He is looking through the Naylor report, which is not included in legislation at the moment, to reduce the estate. There may be some good cases for that, but profit should not be at the head of the argument. We should look at how the estate can be reinvested for the benefit of the community.
Parkland at Bootham Park Hospital in my constituency would make a fantastic public park and would address some of the mental health challenges in our city, which was the purpose of the hospital. I ask the Minister to take a further look at that opportunity. Under Treasury rules, the building and the parkland have to be sold to one private provider. Clearly, that would not work for my city. With regard to the rest of the estate at Bootham Park Hospital, it would be great to see the old mental health hospital converted into key-worker housing to support the rest of the NHS. York is in real crisis with regard to recruiting staff, because they cannot afford to live in the city. If we had key-worker homes on that estate, it would create a sea change. That is about putting public interest at the front, not private profit.
Finally, I want to talk about the future, because I am aware that time is moving on. I truly believe that the only way forward for our NHS is to have one planned public service, with full integration of mental health, physical health, public health and social care, provided in the interests of the community. We need play-space to look after the community, and no more fragmentation. It is ridiculous that we have so many regulators and so many different providers. The whole system is fragmented and fighting against itself. If we had one planned system, it would not only simplify the system, but ensure that the money is invested back into the heart and needs of patients.
Break in Debate
I do not intend to put a formal time limit on speeches. However, there are two Opposition spokespersons as well as the Minister, and I would like to start calling the Opposition spokespersons just after the hour, so if Members could speak for about five minutes each, that would be helpful.
Does the hon. Gentleman also recognise from the data that there is not a similar fall in life expectancy in the Scandinavian countries and that it is wrong to look narrowly at health services, because the biggest driver in relation to life expectancy is poverty?
I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) on securing the debate. The issue of stalling life expectancy, and indeed of falling life expectancy in some areas, is very serious. The hon. Member for South West Bedfordshire (Andrew Selous) talked about living within our means, but people in my constituency are dying early without their means.
We must reach out across the party political divide on this issue, because the constituencies affected are in poorer areas of the country, as has been mentioned, but they are not anomalies; many different parts of the country are affected. I will give an example. Life expectancy for females at age 65-plus has fallen over the past five years by 0.8 years in Stevenage and by 0.6 years in Cheltenham. Life expectancy for males at birth has fallen in my county of Denbighshire by 0.6 years and by 0.9 years in Bromsgrove. This issue affects a great many of our constituents, across the political divide and across the country. There must be the political will for us to understand the root causes of what has resulted in this debate.
I understand why the hon. Lady has asked her question in the way that she has, but we set up the expert working group after a lot of very careful thought because we honestly wanted an answer. We are faced with circumstances in which scientists disagree, and in those circumstances it would not be right for me, as Secretary of State, to announce a different scientific view. I think that the right thing to do is to allow someone the time and space in which to look at the issues that the hon. Lady has raised, and that is what Baroness Cumberlege will do.
That is the right question to ask. I suggested in the statement that we might need a patients’ champion whose job would be to collect the experiences and views of patients who think that they may have suffered as a result of medicine or medical devices. However, we want Baroness Cumberlege to look at the issue in much more detail. The central point is that if we are to avoid the agonies experienced by my hon. Friend’s constituents, the patient’s voice needs to be as strong as the clinician’s in discussions about the efficacy of medicines or medical devices. That clearly has not been happening to date, but I think that we are moving away from the paternalist system that has operated in the past, and the review will constitute a further step in that direction.
Independent living schemes can keep people living healthier, more independent lives for much longer and provide the comradeship and camaraderie that keep people active and healthier. My hon. Friend is right to raise their importance, and the Government very much support them.
What the hon. Lady’s question points to is how we better integrate care as between hospitals and the care sector. That is exactly the issue that the Minister of State, my hon. Friend the Member for Gosport (Caroline Dinenage), who has responsibility for care, is looking at in the Department, to ensure better outcomes from the money being put into the system.
My hon. Friend is absolutely right. What he points to is the variance in performance between some of the best trusts, such as Luton and Dunstable, and other trusts. One of the key challenges is how we ensure that that best practice is better socialised across the NHS, because unlike Labour we recognise that it is not just about how much money we put into the NHS; it is what we get out for that money. Luton and Dunstable illustrates that point, and more trusts need to follow suit.
I echo the points made by the hon. Member for Erewash (Maggie Throup) and by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) in her intervention.
The effect of diet on children’s health is a serious and substantial problem facing our country. If unchecked, poor diet could undermine the health of millions of children. I believe that it risks setting back the historic advances made in children’s health in recent decades, including since world war two.
Child ill health is such a significant problem. It is notable in my constituency, where there is a higher than average rate of child obesity, and there are also significant differences in life expectancy between different parts of the constituency. That is in a relatively typical town in the south-east of England.
Other issues related to health inequality include a growth in the consumption of unhealthy food, which is a particular challenge to families, who are struggling with this issue. Better information and less pressure on parents and children could make a significant difference, as was mentioned earlier.
It is my experience that parents are inundated—I do not say that word lightly—with advertising material on a very wide range of media. Messages about fast and unhealthy food are everywhere—on television, on billboards, on takeaway hoardings, on shopfronts, in newspapers, and in shops and supermarkets when people are purchasing food. They are literally everywhere in my constituency. In contrast, factual information from the NHS or from responsible manufacturers is scarce and hard to find.
I commend those manufacturers and retailers who have taken steps in that regard. My hon. Friend the Member for St Helens North (Conor McGinn) mentioned a company in his constituency and there are many others. I believe that the Co-op shops have a very effective system of colour-coded labelling, warning of the problems of high levels of salt and sugar, and many other retailers and manufacturers are trying that system. I commend them for their efforts in supporting what should be a national effort to help families on this matter. I hope that the industry will do more to promote that approach and that it will work with parents, schools, the NHS, and central and local Government.
However, the contrast between advertising and sensible advice is enormous. To put it in simple terms, a child or parent in my constituency is likely to see junk food advertising when they get up on TV before they go to school, on the way to school, when they come home from school and in the evening. That is simply an overwhelming set of messages that drives people in one direction. Sadly, the messages in the other direction are tiny in comparison and there is limited public money to support them, as was mentioned earlier.
That all adds up to something that is really quite substantial, and in addition we have to take into account the fact that families have also been under the severe pressure of rising food bills. We should take into account the additional problem that many people face, as their incomes have fallen in real terms in recent years, particularly since 2010, while food prices have gone up substantially —I think it may be by 3% at the moment.
Taking all that into account—the power of advertising, the substantial imbalance in information and the pressure on family budgets—I believe that action is urgently needed and I ask hon. Members to support the motion today and call on the Government to listen to this debate, to understand and acknowledge the serious concerns that are being raised, and to take—as was said earlier—bold and brave action to address this issue.