Oral Answers to Questions
Anne-Marie Trevelyan Excerpts(5 years, 9 months ago)
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Matt Hancock
I listened carefully to the right hon. Lady because she has long been a campaigner on health issues, and I very much take her point about knee operations. Of course, the number of EU nationals working in the NHS in England has risen by over 4,000 since the referendum. I know that there are concerns in specific areas, but I hope that we can all take reassurance from the fact that that number has continued to rise. We are determined to ensure that the NHS has the workforce that it needs.
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
I welcome the Secretary of State to his place. I encourage him to visit the most rural part of England, up in Northumberland, to see for himself the challenges to healthcare provision due to the lack of a real rural financial formula. Will he update my constituents and the Save Rothbury Hospital campaign on how the review for that community hospital is going? That sort of low-level care is what makes the difference.
Stephen Barclay
I am happy to discuss with my hon. Friend how we provide support. Addressing the fact that 43% of patients in acutes do not actually clinically need to be in hospital is a key objective of the long-term plan to ensure that we get the right community services and relieve pressure from acutes.
Autism
Anne-Marie Trevelyan Excerpts(6 years, 1 month ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
Every time we have a debate on autism, we bring the issue forward, as the hon. Member for Huddersfield (Mr Sheerman) pointed out.
As someone who has family experience of this—my wonderful 18-year-old son, who has been through the mill, has Asperger’s—constituents are starting to contact me and come and talk to me. They are stepping out into the light and saying, “How do I cope?” Having these debates is genuinely giving confidence to families, particularly mothers, to ask for help and ask how they might find support. As ever, I add my continued gratitude to my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) for all the work she is doing.
Dame Cheryl Gillan
My hon. Friend gives me a good opportunity to say to all those people who email me and contact me on social media that I cannot deal with all the questions and issues that come into my inbox, but I encourage those people to contact their MPs directly, because it is their own MPs who can help them—
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. This is a very important debate. I put a seven-minute limit on speeches to try to give everybody a chance to speak. Given the interventions, I will have to drop the limit for Members lower down the list. I do not think it is fair. Interventions have to be short, and Members should think about whether they need to intervene—especially when they are summing up at the end.
Mrs Trevelyan
Thank you, Mr Deputy Speaker.
I want to discuss waiting times for diagnosis, which are getting better. In the case of my son James, we could not get any kind of diagnosis within the NHS and had to go private. There is not yet the capacity within local areas to ensure that when there is something different with a child early on, there is somewhere to go. I contend the use of language by the hon. Member for Huddersfield—it is not that there is something not right, but that there is something different, and that use of language is important. I say that as someone who has shouted at a lot of people when my son has had a meltdown and said, “If you don’t understand what’s going on, could you kindly go away and keep your opinions to yourself?” That is not normally how I phrase it when I am in a supermarket.
I want to throw something into the mix. As we move forward with so much more work going on across Departments, we might look at having a regional centre of excellence on diagnostics for children on the spectrum, so that we can ensure that wherever we are—whether in the north-east, the south-west, the north-west or Scotland—we know as MPs that we can direct people to a centre of excellence that will be able to help to identify children’s particular needs and so that we never get into the question whether this is about mental health.
Autism is a permanent, different way of being, whether for profoundly autistic children, for whom a great deal of support is required, or those at the high-functioning end of the spectrum—the Asperger’s part—who can be incredibly successful. Some of our greatest inventors and businesspeople are in that space, but if people cannot make it through the basic education system because their needs are not met early on and they fall out of it, that will not happen. Early diagnosis is so important, and I ask the Minister to think about that.
Mrs Trevelyan
Only if it is a brief intervention, otherwise I will get told off again.
Danielle Rowley
That is very generous. Does the hon. Lady agree that early diagnosis has a huge impact on families? I have a constituent who was told that her son had autism at the age of 18 months but did not secure a diagnosis until he was five years old. That had a huge impact.
Mrs Trevelyan
The hon. Lady is absolutely right. Not every council needs a child psychologist who is an expert in the identification of autism, but it would be great if there were one or two across the north-east, in my region, whom we knew we could always tap into. There have not been for years. The situation is getting better, but it is not good enough. We need to think more intelligently about how we provide that resource for families.
I want to talk in more detail about interventions. It is so exciting that the teacher training module will come into the system from September. Before I talk about that, I want to read from a letter sent to me by one of my constituents, a lady called Skye. I have not met her; I have knocked on her door, but there has never been anyone in. She wrote to me about her son, who is four years old and has complex needs. He attends our special school in Berwick. She says:
“Every day so many simple things in life that we all take for granted become a moment of stress, worry and concern”.
She says that could give a vast list of examples of the stresses her child undergoes every day. My heart goes out to her; I was there some 15 years ago, too. She highlights one particular issue:
“Shopping trolleys with child seats are designed for toddlers. My little/big man squeezes into this trolley with pain and distress. I have to lift him above my head because I am only a 5ft mummy.”
Those are the sort of practical things that day-to-day life can throw at mums who are having to deal with this. She goes on to say that
“many younger autism sufferers…have no boundaries, no understanding of the consequence of their actions, and if they have a crisis moment could injure themselves”
by falling out of the trolley or running away. I lost James once in a supermarket, and it was possibly the worst half-hour of my life. She says:
“Being confined to a safe space (trolley seat) is safer for them. It provides an object reference”,
as well as security, as a pram does for a much smaller child. That is a really interesting challenge to us, to think about how we might encourage the tools that can help a family in those public spaces where we go every week.
I almost never took James shopping until recently, as part of our plastics challenge, which I am sure the Minister will join us in. We went shopping and I said, “I’m not buying plastics.” He wanted a particular cheese that only came wrapped in plastic, so he had to buy it himself. There is a lesson for an 18-year-old boy who has never been shopping before: he gets taken shopping, and his mother then makes him do his own shopping.
The reality is that the tools to help people get over the crisis points are vital. I really hope that as the autism module rolls out, teachers are given those tools. James had an amazing teacher when he was six years old. He was not diagnosed, but she could see his meltdowns coming. She told me to bring a beanbag into school, which she put behind her desk. She said to James that whenever it all got too much for him—which was quite often, when somebody was prodding him, he was sitting in the wrong place or he could not see or hear—he was allowed to get up and leave his desk or wherever he was and go and sit in the beanbag behind the desk. The teacher knew where he was, because that is where he always went. The other children did not know or care; they carried on with their school activities. It gave him a safe place that was invisible to everybody else, but they knew he was safe, and then the moment passed.
This is a child who got three A-levels last year and is going to Newcastle to read zoology in September, but when he was seven or eight years old and undiagnosed, nobody thought he would be mainstreamed. He was mainstreamed because teachers thought about how they might give him the tools to get around those moments. We need the teacher training framework to think about the practicalities. These children are simply different, and we have to understand what not being neurotypical means. It is hard for those of us who are neurotypical to understand it.
We must give teachers the opportunity to ask questions. For many teachers in busy classrooms, if one or two children are struggling, the exclusion line is the one that is followed. The behavioural problem kicks in because the child is under a great deal of stress, entirely unnecessarily, and we find those children suffering huge long-term educational failure as a result of the teacher’s inability to intervene early on with something quite simple that can give the child time to recover.
Mike Wood (Dudley South) (Con)
My hon. Friend is absolutely right. It is fantastic news that special educational needs and autism are finally part of initial teacher training. Does she agree that, to make a really big difference, we need to ensure that autism training is a core part of continuing professional development for teachers, so that we can get it into all classrooms?
Mrs Trevelyan
I completely agree with my hon. Friend. That is exactly the challenge. If we can embed understanding that these children simply see the world and react to it in a different way and that those different ways of looking at a classroom space can be all that is required, we can ensure that we get the very best out of every child.
As I often say, if we look at some of our great inventors, we see that the autistic mind is wired differently and therefore sees the world differently. They are an incredibly valuable part of our society’s intellectual value. Without them, we all think the same way. Group-think and moving in a single direction are not where the great stages of improvements come from. We need minds that look at the world in a completely different way. It does not make any sense to me half the time, but that is fantastic, because it throws in something completely different. They can direct change in a way that very few of us who are neurotypical will ever do, and to lose that by allowing these children to fall out of the education system early on is a great loss to society and to our intellectual value as a nation. I hope very much that the Minister will feed that back.
I reiterate that not being able to access support and a diagnosis is a continuing pressure for families that we should not be allowing to go on. When a doctor says, “I can tell you what it is with your child that you haven’t understood: it’s that they’re on the autistic spectrum,” it is like having a weight lifted off your shoulders. At that point, the world makes sense. As the hon. Member for Huddersfield said, you start to understand and be able to educate yourself as a family and bring others in. You still have to shout at people, because not everybody understands yet, but that is okay. You are empowered as a family member, and as grannies and grandpas, because you can understand why this child is not quite like others in the family. You can then move forwards and value them, and really give them the tools, so that they can be the great success that we know they can be.
NHS Winter Crisis
Anne-Marie Trevelyan Excerpts(6 years, 4 months ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is a pleasure to follow the hon. Member for Bradford East (Imran Hussain).
It is depressing to hear the Opposition laying into the NHS, which is an extraordinary group of real people working day in, day out to look after all our constituents when their health needs to be supported and mended. I commend all the staff across Northumberland’s healthcare family who have worked so hard not only over the past few weeks but 365 days a year to look after all of my constituents.
Much can be achieved through good planning to pre-empt the winter health crisis, as it is known, and the increased impacts that winter brings. I have an unfair advantage in Northumberland because Northumbria Healthcare NHS Foundation Trust has been led and built into what it is now under the great auspices of Jim Mackey, whom we lent to NHS Improvement for a couple of years to try to share such skills across the whole NHS. It is lovely for us to have him back, so I thank Ministers for sending him back up to Northumberland.
As a result of 15 years of intelligent planning by senior leadership, we have had no blanket cancellations in Northumberland, and we have an unchanged schedule except only for specific cases. No clinically time-sensitive operations will be cancelled, and most operations are carrying on as normal. In November, the trust decided to transfer one surgical ward to general medicine to ensure greater capacity—thinking ahead to the regular changes that winter weather tends to bring.
We have almost no delayed transfer of care in Northumberland, thanks to the sophisticated planning set in motion by Jim Mackey and his team some years ago, working directly with Northumberland County Council so that our social care and our healthcare work hand in glove. It works, and we are doing it in Northumberland. I urge every MP to encourage their councils to build that relationship, because it genuinely works. I also continue to encourage the Government to make sure our accountable care organisation is one of the first to be signed and sealed so that our holistic healthcare family works for patients.
Flu hit the north-east first, but we are functioning and coping well. Our statistics are good, with bed occupancy at 91%, and yesterday we met our A&E waiting time targets in 95% of cases. Our nursing vacancies are at a historic low of only 1%, again thanks to planning and a positive recruitment campaign in specific staff group areas where we knew there would be shortages. As a result, our nursing agency usage in Northumberland is very low.
Nothing is ever perfect, so I continue to raise the thorny local issue of community hospitals, where our bed provision is currently lower than it should be. Increased provision would help to relieve pressures caused by delayed transfers of care by ensuring that there is support for those who have a level of vulnerability and who cannot, or should not, go home straight from the acute hospital environment. In a rural patch, community nurses cannot practically provide such support in the way that it could be provided in an urban environment. Community nurses just cannot get to as many places in a day when they have to travel miles and miles between patients. The community hospital framework must be part of the new bigger social care model.
I thank both the Prime Minister and the Health Secretary for fighting to bring healthcare and social care together in one place, because that will start to do what we already see in Northumberland. I would like every MP to be able to tell the same positive story in the months and years ahead.
Oral Answers to Questions
Anne-Marie Trevelyan Excerpts(6 years, 4 months ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
I can confirm that the health and wellbeing overview and scrutiny committee has submitted a request for a review by the Independent Reconfiguration Panel. I understand that officials have reverted to the committee to clarify the terms of the referral. Once that has come through to the Department, I am sure that the review will take place.
Autism Community: Mental Health and Suicide
Anne-Marie Trevelyan Excerpts(6 years, 5 months ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is a pleasure and honour to speak in this debate, secured by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), because it is such an important issue. It is critical to make sure that those on the autistic spectrum are absolutely wrapped up in our mental health and medical services so that we no longer need even to raise this issue in the House. To that effect, the Government have put mental health on the political agenda as no Government have before. We have invested more in mental health than any previous Government, hired tens of thousands of staff and, most importantly, enshrined the parity of esteem of mental and physical health into law. The Prime Minister took a big step forward last month by opening a review of the Mental Health Act 1983, because too many people are still suffering discrimination.
Luciana Berger
I do not seek to be partisan in these sorts of debates, but it is important to note for the record that the amendment to introduce parity of esteem for mental health into the Health and Social Care Act 2012 was tabled by Labour peers in the House of Lords, and unfortunately Tory peers voted against it. I would not like the Government to seek to claim credit for the fact that parity of esteem is now enshrined in law.
Mrs Trevelyan
I thank the hon. Lady for her comments.
Despite the cross-party efforts of all those for whom this is a passionate policy area—for 18 years I have cared for my son, who is now a young adult with autism—there are some people who are having a miserable time in the mental health system and are not yet benefiting from improved access to core therapies and services: men and women throughout the country on the autistic spectrum. We must do better.
Across the board, a quarter of us will experience mental ill health during our lives, but within the autism community that rises to eight in 10—of those diagnosed as autistic, eight in 10 suffer from mental ill health. To those of us familiar with autism, that is sadly not a surprise. Society is designed for us neuro-typicals, as my son likes to call me—I am not sure it is meant as a compliment—so almost everything designed for us can cause stress or worry for those who are wired differently. A different perspective on the world has huge potential benefits for our society and economy, and we fail all those on the autistic spectrum to the detriment of not only the individual but society more widely.
We are failing these individuals. When I did some research for this debate—as I always do, if I can, for anything relating to this subject—I was appalled to discover the scale of suicide across the autism community. Autistica, the UK’s autism research charity, revealed international findings that autistic people without a learning disability are nine times more likely to die by suicide than the rest of the population. The charity’s research is now beginning to uncover almost identical rates in the UK as it starts to build the research database. As a parent, that is just awful to hear; but as an MP, it is a rallying cry. The exact causes are still being researched. We live in a complex environment and people are complex anyway. If we stick them in an environment that is often alien, it is not surprising that it is sometimes too hard to cope.
There are three clear ways in which our mental health services are letting our autistic citizens down now, and we have a duty to address them. First, we know that autistic people’s mental health problems are often misdiagnosed or missed completely. Despite mental health problems being the norm, there are no systematic mental health checks for autistic people. These problems can often present very differently, partly because so many become practised at masking their feelings to fit in. If someone is severely autistic, it is perhaps almost easier to identify them as sufferers, but those who are managing to live in a mainstream environment have learned some extraordinarily clever, adaptable ways to cope with our neuro-typical world and to their own very severe mental ill health. What is truly traumatic for one autistic person might not be for another, so when they do seek help, as the hon. Member for East Kilbride, Strathaven and Lesmahagow highlighted, autistic people can often find that their worries are dismissed out of hand. They are missed or misunderstood.
The NHS Five Year Forward View for mental health recommends the development of autistic-specific care pathways for mental ill health. That work, as I understand it, is supposed to begin in 2018, but we have heard nothing about it since February. Perhaps the Minister will be kind enough to update us on the project: is it still taking place; who is leading it; what is its scope; and how will autistic people be involved in helping to design it to make sure that we are not missing some very obvious things? Those things might not necessarily be obvious to those of us who are neuro-typical, but we must think in the different way that our wonderful autistic community so often does. This is a crucial opportunity to begin transforming care for autistic people, but we must get it right.
Secondly, we know that autistic people can struggle to find the support that works for them. It is assumed that what works for us neuro-typicals will also work for them. Autistic people may benefit from cognitive behavioural therapy but, as the hon. Lady who is an expert in providing such support says, being made to group work with strangers can be entirely counter-productive. We need to think about how we can adjust that support. The idea that someone who has issues with understanding, with being able to read faces, with processing information would in any way feel supported when they are in a state of deep stress shows a complete gap in understanding. The stresses and the symptomatic problems of people with autism make it more difficult for them to cope.
Dr Cameron
The hon. Lady is making an extremely powerful speech, as she is speaking from very personal experience, which is extremely valuable in this Chamber. I have also heard some disturbing accounts in the past few weeks of people with autistic spectrum disorder being referred to group-based therapies, which also shows a lack of awareness of symptoms, as they have issues with being able to interact socially and to communicate. That would place an individual with autistic spectrum disorder under even greater stress than if they underwent a different form of therapy.
Mrs Trevelyan
I absolutely agree. I work closely in my constituency with the families who are supporting their autistic children. Clearly, dealing with strangers, with the unfamiliar, and with group dynamics is possibly one of the most difficult things to ask an autistic young person—or indeed an older person—to take on.
We have for too long neglected the research into mental health therapies for our autistic community, even though that tops the list of research priorities if we ask those in that sector. I very much hope that the Government will look to support those who are doing this work. In our manifesto, we said that we
“will address the need for better treatments across the whole spectrum of mental health conditions”—
by—
“making the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.”
I support those words wholeheartedly and hope that the Minister will be encouraging and will help us to do much more.
Thirdly, let me mention NHS data gathering—this is an issue that comes up in any number of NHS-related debates, but it is critical in this one. GPs are so often the first port of call for those with mental ill health. Going to a GP can be really, really difficult for autistic people. It is an environment with unfamiliar lighting, sounds and rules that cannot be escaped. The hon. Lady’s example of a bell going off is a classic one. It is the unfamiliarity and the pitch of the unexpected sound. There is a lack of understanding by neuro-typicals about what certain pitches of sound can do to those who have hyper-sensitivities. To an autistic young boy or girl, it can be like a bomb going off. We need to consider the impact of such things on those with these heightened sensitivities, especially when they are in a strange place and already in a state of anxiety. Strip lighting in public spaces is another thing that creates enormous tension.
Paula Sherriff
The hon. Lady is making an incredibly powerful speech. Some supermarkets, including Sainsbury’s, do an autism hour—every month, I think—which is great, as it provides literature in store for people, and staff also gain a better understanding. If a child or young person is having a meltdown, people should not think automatically that they are naughty but consider that they might be experiencing difficulties relating to their autism.
Mrs Trevelyan
The hon. Lady is exactly right. I have experienced many times the meltdown of a small child in a supermarket aisle and had people either offer a word of support or—usually—criticise me for being a bad parent. The line I always used was, “You tell me when you have an autistic child and take them shopping, and I’ll tell you what the problem is”. It is very difficult to understand. We need to provide places of calm. Cinemas do it, and we can do it too. I ask that the Minister take this forward and take on the challenge of getting those quality and outcomes frameworks to work so that our GPs can provide the support that people need.
Several hon. Members rose—
Mental Health Units (Use of Force) Bill
Anne-Marie Trevelyan ExcerptsFriday 3rd November 2017
(6 years, 6 months ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is a pleasure to follow my hon. Friend the Member for Hertsmere (Oliver Dowden), and I congratulate the hon. Member for Croydon North (Mr Reed) on all his work in bringing this Bill to the Floor of the House which, as my hon. Friend the Member for Banbury (Victoria Prentis) highlighted, is an extraordinary feat. I have only been in the House for two years, but it is evident that to beat the systems of the parliamentary process and bring together so many voices to ensure that an important gap in our legislation can be addressed is really impressive, so I am delighted to speak in support of his Bill.
How we view, diagnose and treat mental health has changed dramatically over the past few years. I am delighted that our Conservative Government have taken a lead on this matter now, but we still have a long way to go. Excellent work by health professionals, the royal colleges, many excellent charities, many parliamentarians and citizens from right across society is starting to ensure that mental health is, at last, right up at the top of the Government’s and society’s priorities. Bearing in mind just how much the picture has changed in recent years, it seems somehow incomprehensible that the Mental Health Act has remained unchanged since it was enacted in 1983, which was when I started secondary school—and I am definitely not one of the younger Members in the House.
To think how policy has changed, even over the past decade, reminds us of just how an Act passed three decades ago can no longer be anywhere near fit for purpose. In some ways, it is a good thing that we have moved so far in understanding what mental health means—and, in fact, what mental ill health means. I often find it a strange use of language to talk about mental health when we mean that somebody is unwell, because it is a moment in an otherwise healthy person’s life when they are unwell. As my hon. Friend the Member for Hertsmere said, it is an invisible part of our health and ill health through, for most of us, our now fortunately very long lives.
It is great news that the Mental Health Act review is ongoing, and I look forward to continuing to work with the Government and Ministers to ensure that we get effective reform across the board. This Bill will allow us to address the use of force in mental health units, about which I have had a substantial amount of correspondence from concerned constituents and, interestingly, more widely from family and friends who often say, “I don’t want to bother you, Anne-Marie, because you are very busy in Parliament,” because this is something that really bothers people, and they have dropped me a line to highlight the fact that they want me to speak out.
Sarah Jones (Croydon Central) (Lab)
I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on introducing the Bill, which is important for the country and for Croydon. Seni died in Bethlem Royal Hospital, which is on the border of my constituency, and my love and support go to his family and friends for what he suffered.
A constituent came to me this week who had had a bipolar episode, ended up in a prison cell, and been assaulted. He said that “a police cell is often the first port of call for people with mental health issues, especially those unfortunate folk who, for one reason or another, end up on the streets like I had to go through.” He went to a solicitor to ask whether he should take action, and he was advised not to do so. Does the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) agree that the Bill will change practice within mental health units and will also hopefully encourage people, when things go wrong, to speak out, to take action and to feel that they will be supported in doing so?
Mrs Trevelyan
I thank the hon. Lady for her intervention, with which I absolutely agree. I am pleased that the number of people being held in police cells has fallen dramatically in the past few years, but, as we have seen this week, if people feel that they are suffering injustice, they should always take it to the police or, if that is where the problem or inappropriateness lies, find another outlet to be heard and to get redress. Every citizen of our country should always feel able to stand up and say, “This was wrong, and I am seeking redress for what was done to me.” I encourage the hon. Lady to support her constituent in seeking redress.
Many constituents have written to me with deep concerns about the effect that the undue use of force might have had on their child—and, in three harrowing cases, the effect that it has indeed had. One constituent detailed how the use of unreasonable restraint had a lasting effect on the health not only of the particular family member but on the whole family, which created years of trauma and ongoing illness. The use of excessive force can lead to long-term damage, and, as in the tragic case highlighted by the hon. Member for Croydon North, a death is an absolute travesty. We can never allow such abuses to take place in our civilised society.
It is good that cases of such terrible treatment are rare and that the numbers are coming down, but if we ever treat with force and brutality people who desperately need our help and support when in a state of mental ill health and distress, it is time for those voices to be heard and for action to be taken. These abuses cannot go unanswered or be tolerated any longer. The movement towards understanding mental ill health is progressing, and the Bill will help to change practice.
With that in mind, I will address two specific issues that are extremely close to my heart: autism and young people. There has previously been a lack of cross-Government co-operation on mental health issues. If we are to make a real impact on this issue and to change cultural norms, we need to ensure that the Department of Health, the Home Office, the Ministry of Justice and NHS England have closer working practices to deliver the necessary detention reforms. I hope the Minister will confirm that to the House later today.
The Bill could make a real difference in tackling the inappropriate force that is too often used against patients, many of whom are on the autism spectrum. A recent freedom of information request discovered that there were 66,681 recorded instances of restraint in England in 2015-16, an increase on the previous year. The use of physical, mechanical or face-down restraint can undermine an individual’s recovery and increase their risk of injury and long-term harm. As a society, we should be charged with protecting and helping those people to get well again.
I would hope that many in this House have read the National Autistic Society’s recent report “Transforming Care: our stories”. The report follows 13 families with a family member who is on the autistic spectrum or who has a learning disability and who is at risk of being admitted to an in-patient mental health hospital, of which there are still 2,500 across the country. One story spoke of a boy who was, according to a serious case review, “completely failed”:
“A very vulnerable young man suffered a sequence of traumatic experiences which may adversely affect him for…years.”
I am the mother of an autistic young adult—he has just turned 18—and I have other family members who are now diagnosed, and I am constantly concerned that the invisibility of autism in so many sufferers means that their mental health, or mental ill health when it hits them, has completely failed to be understood or, indeed, identified in crisis situations.
I used to have to ask teachers at my son’s school who did not understand how his Asperger’s affected him, “If he had a broken leg, would you ask him to run up the stairs or to join in a football match?” They would look a little bemused, and I would say, “He is in a state of deep stress and trauma at this point. You are expecting him to sit quietly in a classroom and pay attention, as when he is in a state of wellness. This is not possible.”
Teachers committed a huge amount of time to helping him to be in the mainstream system, and it took two or three years to understand that the invisibility not only of autism but often also of mental ill health until a crisis hits means that society cannot see it. Unless we are particularly attuned to the individual sufferer, or indeed to a wider understanding and identification of what that means, we cannot help them. It is important that people charged with looking after those who may be in need have rigorous frameworks and training. Just as we would not ask a boy with a broken leg to play in a football match, we must not have similar expectations of those in mental health crisis.
What can we say when we hear such harrowing stories, which are much more tragic than we should ever have to hear, and have to imagine the tragedy that those families have had to go through? How do we react? The instinct can no longer be to allow things to continue. We need things to improve, but we cannot just make tweaks here and there. The House cannot ignore issues that need urgent attention and reform. I am glad the Government recognise that and are supporting the Bill.
These isolated cases are sadly too common, and NHS Digital figures show that autistic young people still have an increased risk of being unnecessarily and frequently restrained because they cannot express their anxieties and crises in the way that neurotypical people more often can. We cannot continue with outdated practices and restraints that severely endanger the most vulnerable, who need considerate, appropriate and constructive treatment programmes that meet the autistic individual’s needs.
The Bill includes provisions to turn that into reality and to reform practices in mental healthcare, and it highlights a number of concepts that our constituents expect of us, of the Government and of our public services right through the system. I will cover a couple of those concepts.
First, on transparency, every time restraining force is used in a mental health unit it will be recorded and fully detailed. This would allow people to know that if this happened when they were in a state of mental ill health, it would be recorded; often people are not able to think clearly in these situations. Where someone has a broken leg or a broken arm, their mental capacities are still functioning fine and they will remember if the cast was put on the wrong arm—they would notice that. However, people in a state of deep mental ill health are not always able to see the world clearly at that point, so to have that fully detailed record will make a big difference to empowering those sufferers to know that they are being properly looked after.
In all our major institutions, such as the police or the NHS, we need accountability in everything that is done for our constituents. That is no mean feat in practice. This Bill will mean that every institution will have to have a named individual responsible for policy on the use of force and implementation. Given the discussions this week in the House, it is perhaps prescient to have a named person to whom those in distress can go, safe in the knowledge that they will be supported, understood and given a fair hearing. That is so important.
Dr Drew
Does the hon. Lady accept that the named individual must be able to prove that they have been trained in handling these incidents responsibly and, particularly, that they have been retrained on a regular basis? One weakness of the units is that there is not only a lack of training, but certainly a lack of updating of people’s training.
Mrs Trevelyan
I thank the hon. Gentleman for his intervention, and I agree absolutely that we need to get the training right in the first place; understand unconscious bias, which we all invariably suffer from, not only in general life, but within the complex environment of mental ill health; and ensure that de-escalation techniques are learned and constantly reiterated. Such an approach would allow the extraordinary people who work in this sector to be supported, constantly reminded of things and given the right tools to ensure that they can look after our family members and our constituents when they are in these crises.
Helen Whately (Faversham and Mid Kent) (Con)
One notable thing in the evidence about this is a huge variation in the use of restraint: in similar settings with similar groups of patients far more restraint is being used in some areas than others. Getting to the bottom of that when trying to improve the standards in all settings is surely part of the key to solving this problem.
Mrs Trevelyan
I thank my hon. Friend for that intervention. She is right: so often the circumstances of patients in the units has meant that people have been able to develop more sophisticated techniques and de-escalation programmes, and this best practice needs to be shared. That is the great challenge, as it so often is in education and in other parts of our public services. We need to find an effective way to share these best practices, so that we can help people who are doing their best in units across our constituencies but who are not necessarily using the most effective tools to help patients recover and restore their stability.
These two key policy areas, transparency and accountability, will protect patients, and promote dignity and respect. Everyone who passes through our mental health system should receive dignity in their care and respect for them as an individual in our society. I had a lovely chat with a gentleman on the street last night, not far from here. He was asking for money because he needed £35 for his bed and breakfast last night—this was going to be his night of luxury—and he had with him a sign saying, “This can happen to anyone.” That always makes me stop to chat. His life story was just unfortunate, with a series of unfortunate events, and there he was on the streets. Mental ill health can strike everyone, so to suggest that not everyone is entitled to that dignity would be wrong.
Oliver Dowden
My hon. Friend raises an important point. Does she agree that we must be careful not to judge people in that situation? There is always a temptation to think that there could be other reasons for it, but often they come from terrible circumstances, for example, having been the victims of child abuse and so on. There still needs to be a change in society’s attitudes, as we see when we look at some of these appalling cases of these people being abused by other members of the public.
Mrs Trevelyan
My hon. Friend is exactly right. It is incumbent on us as we go forward with this Bill to set these new markers to ensure that we get a cultural change; we need that understanding that mental ill health is part of our life experience and most of us may well suffer from it in one form or another. For those who are the most vulnerable we absolutely need to ensure that the practices are the best they can be, so that dignity and respect is afforded to every person who needs that support.
Transparency and accountability will also allow health professionals and emergency staff to manage the risks, protecting not only the patient, but our public servants. This can protect them from false allegations and allow us to have that evidence should things go wrong. Body-worn cameras are so important in this regard. The prison in my constituency, HMP Northumberland, was one of the prisons where body-worn cameras were trialled. This has been running for nearly two years now and there has been a dramatic drop not only in the reported cases of argy-bargy between prison officers and inmates, but in poor behaviour, because inmates who might have decided to have a go cannot be bothered anymore because they know it is going to be filmed; the relationship has improved so much as a result. This has created the same thing as we see where a teacher has good discipline in the classroom, understanding that if we provide a framework everyone within it works in a more conciliatory and more constructive fashion.
Victoria Atkins
I am a huge supporter of body-worn cameras on police officers and on prison officers, because I believe it protects not only them, but members of the public. Does my hon. Friend agree that just as—I hope—body-worn cameras will help victims of domestic violence who perhaps do not have the confidence to give evidence against their assailants, or cannot face the consequences of doing so, the same thing may apply in respect of prisons?
Mrs Trevelyan
My hon. Friend is absolutely right. Interestingly, even in the social media world we all live in, a storm of anonymity allows a level of poor behaviour. If the body-worn camera empowers people to remember that anything from good manners and good behaviour to constructive dialogue rather than more violent interventions is the way forward, this must be a tool we should be encouraging across the board. One hopes that behaviour can improve once people remember how these things can be done more constructively and with less violent interventions.
Kevin Foster
Does my hon. Friend also agree that one bonus of footage from body-worn cameras is that people have to go through a less lengthy investigation? Such investigations take the police officer off duty and put them on gardening leave. Having the certainty these cameras provide means that for both sides a quick resolution can be reached, and the organisation can then move on.
Mrs Trevelyan
My hon. Friend is exactly right. These common-sense measures could have a dramatic impact on the way our mental health units work, and for the well-being of both staff and those who are there receiving treatment.
Another important aspect of the Bill is the proposal that justice for a potential victim would now become possible. Our country and our values are based on the rule of law, but for justice to be done we need a new and open approach which would allow our public services to learn from past mistakes and ensure that no family or individual has to suffer the tragedy of loss or injustice that has too often been experienced by patients and their families. I have a constituency case in which a young girl had been put in restraint, not within a mental health unit, but within a special school environment, and, as a result of the fits from which she suffered, she hit her head and lost her sight. That is truly tragic, and the family has fought and fought to find a way to get redress and a better educational framework for this child to learn, having developed this entirely avoidable blindness. There is a great challenge in ensuring that we have a system that is open and transparent, and that families can be heard and do not have to fight for years.
Helen Whately
My hon. Friend just mentioned a case in a special school. I know we are talking about mental health units, but I wish to raise in the House the concern that exists about restraint in special schools. A case in my constituency involves some autistic boys having gone through some really concerning restraint when they were quite young, which gave them serious bruising. They have now been taken out of that setting, but we have never really got to the bottom of what happened there. This feels like something that needs to be looked into.
Mrs Trevelyan
I would be happy to work with my hon. Friend on that. Perhaps it is something we need to look at more widely. The extraordinary staff at special schools look after children with a breadth of needs that are never the same for two days running or for any two children. We must ensure that they are empowered with the right skills and techniques to support these children, who can lead fulfilling and full lives if we can get them through the education system. As I used to say to my son—I shall namecheck him again; he hates it when I do this, but tough, it is too late—it is really difficult for a child who sits outside the norms to be in the mainstream education system, but if they can make it to adulthood, they are free to be whoever it is that God created them to be and can really flourish. The challenge for our public services, whether for those who suffer from ill health or for children in special needs schools, is not only to ensure that we have a framework that supports them and wraps them with the skills and techniques needed to help them to develop and get well, but to ensure that they are treated with the dignity that everyone would expect for a family member who was in hospital for any other physical ailment.
The proposals in the Bill are really important to me personally and profoundly important to so many of our constituents who have experienced restraint and whose families have lacked a voice on the protection of children or relatives in these situations. Indeed, many have been unable to get any form of justice or restitution for damage to their family members. Legislation can change our practices and, in turn, our attitude towards how we care for those who need it the most. I am delighted that the Bill has been introduced and give it my wholehearted support.
Rothbury Community Hospital
Anne-Marie Trevelyan Excerpts(7 years, 2 months ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is an honour to have finally been successful in the debate ballot and to bring the issue of the proposed closure of in-patient care beds at Rothbury community hospital to the House and to the Minister today.
Rothbury is a thriving small town at the heart of the Coquet valley community in my constituency, in Northumberland. The valley is a large, very rural and sparse community of over 5,000 people across hundreds of square miles, and it runs from the A697 at its eastern edge across to the Cheviot hills and the Scottish border to the west. Small villages and hamlets are dotted across traditional agricultural territory with mainly upland sheep farms, some of which are within the Northumberland national park and the Otterburn Ranges—the Army’s largest training base in England.
Families’ commitment to living in this idyllically beautiful but quite challenging day-to-day environment is vital to the land management necessary for our tourism, our farming and our military needs as a nation. Over 30% of those living in the valley are over the age of 65—a figure that will only grow, as Rothbury and the surrounding villages are wonderful places to retire to or for people to stay in long after their children have flown the nest. Therefore, we must plan for the right long-term, sustainable healthcare offer for this close-knit community of families and businesses and for the unique challenges they face.
The local community hospital has, until now, provided 12 in-patient beds, primarily for palliative, post-operative recovery and respite care. The clinical commissioning group reviewed activity data last year as it brought in a system-wide approach to discharging patients home, and average bed occupancy in Rothbury was 50% through 2015-16. The CCG declared that to be too low to be sustainable.
As a result of nursing workforce challenges across the Northumbria healthcare trust—albeit that we face fewer challenges than the rest of the UK, thanks to our excellent forward-thinking trust, doctors and managers—the reality is that we do not have the nursing capacity adequately to cover the 12 in-patient beds at Rothbury at present. A combination of those workforce challenges, and the under-occupancy concerns cited by the CCG, meant that the use of those in-patient beds was suspended temporarily in September 2016.
Where I part company from our hard-working CCG on this issue is that I believe that those beds have been empty not because of a lack of demand, but because decisions have been taken to send people home to receive community care, or to Alnwick infirmary to receive in-patient care. As a result, Alnwick infirmary has been running near to capacity for some time, and those in the north and east of my constituency who might otherwise have been sent there have been forced to remain in the urgent care beds at the UK’s first specialist emergency care hospital at Cramlington— our new specialist care hospital for the whole of Northumberland and north Tyneside—for longer, placing greater strain and expense on our healthcare system than necessary.
If this in-patient ward is permanently closed, that will have negative impacts on my Coquetdale community and greater financial implications for our NHS across Northumberland. In particular, the challenge is that we do not have anything like enough community nurses and carers adequately to support those older patients who are sent straight home with their transition back to independent living. It has always been a challenge for our community teams, working across rural Northumberland, to see anything like the number of patients in one day that they would see if they were based in a town or a city, because our CCG is not funded to commission enough community nurses to genuinely provide the amount of care to meet the extra challenges that this sparse and disparate community generates. If a community nurse needs to visit someone three times a day but her other patients are 30 miles away, she will make three or four visits a day rather than the 10 or so that an urban-based community nurse would be able to make. Many of our older people who have received medical interventions live alone or have elderly partners who are no longer able to be full-time carers themselves. The value of a step-down care transition provided by a few days of recuperation at Rothbury community hospital would have medical as well as psychological value for these communities.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my hon. Friend on the powerful case she is making for her rural constituency. Has she been able to compare and contrast the cost of a community hospital bed with the cost of a bed in the district general hospital to which she referred? I suspect that she has done so and will have found that there is a yawning difference between the two—a very good argument for community hospital beds.
Mrs Trevelyan
I thank my hon. Friend for making that point. This issue is critical, and it has brought some confusion to the community, who felt that the financial model did not seem to make sense. Why keep someone in a very expensive acute bed for longer than necessary if there is the capacity to have a local relationship with nurses who know the community very well? This is part of the CCG’s work, obviously, but we need to be very clear about it to be sure that we are not making a bad financial decision in the longer term.
As a result of this consultation, residents across the Coquet valley who have needed admission to an acute ward may well now find themselves staying longer than necessary on that acute ward; being re-admitted to an acute ward for lack of adequate rehabilitation care at home; sent home with inadequate support from an over-stretched community nursing service; or, at best, sent to recuperate in a different community hospital much further from friends and family, placing extra pressure on alternative populations needing to use that provision.
When, back in September, the decision was taken to temporarily suspend admissions to Rothbury community hospital for a period of three months, I wrote to every household across the valley calling on them to share with me their own experiences and concerns about the proposed threatened closure of the in-patient beds. The message came back loud and clear that being near family and their own community while they recuperated, or ending their days with dignity and privacy in the valley they have lived and worked in rather than dying at home alone, is invaluable. I know that this Government want our world-class NHS to provide not only the best medical interventions but the respect and provision of dignity for every patient while they are under its care.
The Coquet valley is frequently cut off during winter months, making travel to Alnwick infirmary to see loved ones receiving care especially difficult and sometimes not possible at all. Even during the summer months, there is little public transport to connect the valley and Rothbury to Alnwick. The ability of loved ones to visit patients receiving care at Rothbury community hospital was cited time and again to me as one of the primary reasons the in-patient beds are so vital to my constituents. The value of our community hospitals is often overlooked and certainly cannot be quantified when, too often, consultants have not been made aware of their option to transfer patients to receive care in Rothbury.
My constituents have come together in an extraordinary show of unity to speak in one voice under the banner of the Save Rothbury Hospital Campaign—4,500 people have signed the petition calling for the reopening of the ward. Our CCG has worked closely with the campaign team, for which I thank them, particularly Dr Alistair Blair, who has so many pressures on him and his team at this challenging time, and has invited us to bring forward a proposal that would see the beds made available for step-down and end-of-life care. I am concerned, however, that the CCG is telling me that because it does not commission respite or palliative care services, these cannot be part of a sustainable solution, as the valley residents would hope.
Northumbria Healthcare NHS Foundation Trust is one of NHS England’s vanguard trusts with its sustainability and transformation plan, and it will be the first accountable care organisation in England in the coming months, so surely we should be able to ensure that integrated care can work in one of our most challenging geographical locations. The University of Leeds is currently conducting a study called, “Cost Structure and Efficiency in Community Hospitals in the NHS in England”. The Public Accounts Committee, of which I am a member, regularly challenges NHS England on how it spends taxpayers’ money to deliver the best integrated health and social care provision. I know that the Minister is working hard to drive this forward, and we encourage him to go further, but until the results from the University of Leeds are published, the Minister has little economic evidence of the value of the intermediate care provided by community hospitals with which to work on the sort of sustainable solution that I want to see for our community hospital in Rothbury.
Dr Murrison
My hon. Friend is being generous in taking interventions. I am interested in the study to which she refers. Does she agree that a likely outcome of the configuration of healthcare in the longer term will be increasing specialisation at really quite large district general hospitals? If that is the case, there will be an even greater need for community hospital beds—step-down, step-up care—otherwise people’s only access to in-patient care will be at one of the huge regional or sub-regional centres that I suspect our NHS will be developing in the years to come.
Mrs Trevelyan
I thank my hon. Friend for his comments. We are unwittingly seeing what he suggests already. In Northumberland, we have an extraordinary specialist A&E hospital, with which we have led the way in England. It has drawn much more attention and patient focus than perhaps any of us expected, because there in one place are all the specialisms, with the best maternity care. The result is that patient needs have migrated to it.
However, we now rely much more than we should on sending patients straight home, whereas we should be using community hospital beds to provide the best step-down care for our older people, in particular, who really need that support to get back home. Getting home, getting up and about, making their own cups of tea, moving around and avoiding the risk of muscle wastage caused by staying in a hospital bed are real issues for them. As medical science moves on and that becomes more and more clear, in-patient bed units in community hospitals should probably adapt to reflect that. Such units must help to preserve the mobility of people who are taking that step-down approach to going back home; the term “in-patient bed” should not mean that they are stuck in their beds. We understand that continued movement and redevelopment of muscle are important in rehabilitation, and we must absolutely make sure that patients are not left in the wrong part of the NHS when they are trying to get back home after extraordinary medical interventions. Those interventions are now developing very quickly and giving us the opportunity to live much longer.
I therefore call on the Minister to pause the CCG’s consultation and the plans to close permanently the in-patient beds until the results from the University of Leeds have been published. Northumbria Healthcare NHS Foundation Trust is leading the way in establishing an accountable care organisation—a model that many people buy into and understand the value of. We all instinctively assume that the NHS is one block, but of course it is not; it has always been made up of separate parts, which work better or less well depending on where they are. The accountable care organisation offers a real opportunity for streamlining and making the flows work much better. We will be the first to do that in Northumberland, so we should be the beacon for fully integrated community care—making the best use of our taxpayers’ money and ensuring that my constituents have the most appropriate and supportive care framework —rather than being a victim of the short-term workforce challenges with which the NHS is struggling.
Health and Social Care
Anne-Marie Trevelyan Excerpts(7 years, 2 months ago)
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Meg Hillier
My hon. Friend puts a face on the real challenge faced by many trusts and commissioners: they are having to make choices about where to spend the money. Despite the pledges about parity of esteem, there is a squeeze on mental health funding nationally.
The reality of the overall picture is that growing demand is outstripping the ability of the NHS to supply needs, which is having a direct impact on patients. There are now longer waiting times for GP appointments. I alert colleagues to the Public Accounts Committee’s hearing on GP services next week; any thoughts from hon. Members’ areas are welcome. People are waiting longer to see specialists, with the 16-week target being breached, and A&E targets are being breached too often. There is a real challenge.
NHS Improvement is a welcome body for trying to encourage best practice, because there is regional variation. It is quite right that any body as large and expensive to taxpayers as the NHS looks to perform as efficiently as possible but, once again, we are seeing NHS Improvement mask what look like cuts. A 4% efficiency savings target is once again being imposed. It was imposed in the previous Parliament by the then Chancellor, the right hon. Member for Tatton (Mr Osborne), and was acknowledged by the head of NHS Improvement, Jim Mackey, as particularly challenging. Worryingly, the reality was that everyone in the system knew that the target was too challenging, but there is a real lack of a culture of whistleblowing and calling it out in the NHS. It is difficult for people to speak truth to power, as we see over and over again. The head of NHS Improvement again acknowledged to our Committee recently, as mentioned in our report, which was published today, that the 4% efficiency savings required as part of the transformation programme are “challenging.”
Our report also describes a worrying correlation between the financial performance of trusts and their Care Quality Commission ratings, stating:
“Trusts that achieved lower quality ratings had poorer average financial performance, and the 14 trusts rated ‘inadequate’ together had a net deficit equal to 10.4% of their total income in 2015-16.”
That is a real issue.
I will touch on workforce planning before beginning to draw my comments to a close. We hear a lot about the cost of locums. Very often in the national debate, I worry that we fixate on smaller issues when we really need to look at the bigger picture. We often hear about the very high rates per hour or per day paid to individual locums. That certainly is a problem—paying someone several thousand pounds a day or a shift seems ludicrous—but the key issue is the sheer volume of locums needed.
Each year, the trust structures are set to meet the budget sent down to them from the Department of Health—our tax money, but not enough of it. From the beginning, they are just not set up well enough to meet demand. Trusts have to buy in locums to meet the needs of their populations, but that is not sustainable in the long term. There were challenges, with a reduction in the number of nursing places in the last Parliament, which is coming through now. We have recently seen the loss of the nursing bursary, which we hope does not mean a reduction in the number of nurses in the future. However, many women, particularly lone parents, in my constituency welcome the opportunity to better themselves and contribute to our NHS by taking that on. I hope the Minister will give us an update on the numbers of people going into nursing training now and, crucially, on whether the people taking those training places will stay and work in our NHS, especially given Brexit and immigration issues.
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
My local foundation trust, Northumbria NHS Trust, has taken to training its own cohort of nurses so that local people who want to join the nursing profession will be able to do so knowing that they will be able to work in that local trust, which has a great reputation and which is leading the way on the financial and medical changes we need to see.
Meg Hillier
I agree with the hon. Lady. My own hospital does the same, taking on healthcare assistants and bringing them up through the system. The challenge is: how many people will be put off without that bursary payment? We need a clear answer from the Minister about what analysis was done of the impact on the workforce of that change. The amount of money involved is relatively small compared with the challenges and problems of not being able to provide a health service if we do not have enough nurses.
North East Ambulance Service
Anne-Marie Trevelyan Excerpts(8 years ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
I represent a very rural seat in north Northumberland, where, in January 2015, we had the tragic case of the entirely avoidable death of a young man because an ambulance did not get there in time. The Secretary of State instituted a national review on the back of that to look at the issues that triggered that tragedy. I am grateful for that, and we have made progress.
Some issues have come out of that, and the North East Ambulance Service should be commended. In my area, ambulances go to Northumbria hospital—our new emergency-only hospital. Some colleagues have already mentioned that we have been seeing the queuing of ambulances as they arrive at the various hospitals. I am not familiar with the wider north-east hospital framework, but at Northumbria it was quickly evident that that was a problem. To its credit, the North East Ambulance Service sent a paramedic to help in the triaging process, along with a specialist nurse who was diverted from other duties, to improve the process when the ambulances arrive—the hospital knows when they are going to turn up because they phone ahead—and to do a better job in ensuring that patients were removed from said ambulance and that the kit was returned to paramedics so that they could crack on with the next case.
That has been working well. We have seen a much speedier process, so I would commend that to colleagues, who could encourage other hospitals in the region to look at doing that. That has been an investment, but without doubt the cost-benefit not directly to the hospital but to the overall health package for our constituents has been hugely improved, because ambulances are back in the system. We were also then able to ensure that Northumberland-based ambulances were coming back up into Northumberland and not being taken to 999 calls elsewhere in the region, leaving paramedics working 14 or 15-hour days to get the ambulance back to Berwick or Alnwick. I commend the ambulance service for listening on the challenging problems we had and trying to make improvements.
At Northumbria hospital, the figures for urgent and emergency attendances read like this for the past three months: January had 12,911, which was a 12% increase on 2015; February had 13,731, which was a 30% increase on 2015; and March had 15,146, which was a 24% increase on 2015. However, only 24% of those cases needed emergency hospital admission. Something is broken. We are overloading our ambulance service with calls that demand an emergency ambulance, but, once at the hospital, only 24% needed emergency care.
My concern is twofold, and I ask the Minister to look at how we can make progress on this. First, the algorithm that the 111 and 999 systems demand that staff in the call centres use is dramatically risk-averse. I do not want anyone who is having a cardiac arrest to be told they have heartburn and not be sent an ambulance; quite the opposite should happen. However, a few years ago, the North East Ambulance Service built the lower-level 111 system and tested it before it was rolled out around the country.
Mr Kevan Jones (North Durham) (Lab)
I hear what the hon. Lady says, but is not the real problem that 111 was rushed in and relied on technology? When it originally started, we had trained paramedics in the call centres who could categorise cases. There is clear evidence, which I will present, that, if something is not deemed life-threatening or someone is not having difficulty breathing, the case is categorised as green. The figures produced are meaningless.
Mrs Trevelyan
I thank the hon. Gentleman for his comment. Quite a few of my constituents were among those experienced staff. Some were retired midwives or had worked as nurses and then moved into the call centre framework. There was a big shift a few years ago to downgrade the medical qualifications required for those staff. We are starting to see a change in that, because the new chief executive is mindful that the huge increase in demand is partly down to staff’s inability to assess cases correctly. If they took another 30 seconds, they could assess properly the situation on the end of the phone.
Will the Minister work with the people who are writing the algorithm and building the system to get it right? The ambulance service personnel would then have a better tool to work with. That would also encourage ambulance services, and not just our own in the north-east, to go back to higher-value trained personnel who can ask the right questions and get the right answers, so that we do not end up with over 70% of emergency calls ending in someone getting to hospital and finding that urgent care was not needed.
The other side of this issue, which I have been campaigning on with St John Ambulance, is the need to help families to be better educated so that they can assess their own medical conditions. Other than for cardiac arrests, strokes and such evidently dramatic changes, it is often not emergency care but urgent care that is required. We need to encourage people and build their confidence in assessing for themselves whether they should go to the pharmacy or the doctor or call for an emergency service. We need to do that across the board, focus on it and drive it forward.
St John Ambulance wants to get into every single school, so that we are teaching young children the difference between what to do if they burn their finger on the kettle—put it under the tap, instead of dialling 999—and what to do in an emergency, such as if granny falls down the stairs. The next generation would then have confidence in knowing the difference between when emergency care is needed and when they can manage and find the right care over a longer period.
Our paramedics will not be able to continue meeting the demand, much of which is inappropriately placed on the ambulance service. We should make much better use of our amazing paramedics and ensure that retention is higher, because they are valuable members of our community.
World Autism Awareness Week
Anne-Marie Trevelyan Excerpts(8 years ago)
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Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
I congratulate my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate and on her tireless work over many years to raise awareness of autism and to start to change Government priorities around those in our country who are not neuro-typical beasts.
My hon. Friend the Member for Bury St Edmunds (Jo Churchill) and the hon. Member for Argyll and Bute (Brendan O'Hara) have described movingly some of the experiences of families and those who suffer from autism. As my right hon. Friend’s Autism Act 2009 was going through the House, I was battling to find support and a diagnosis for my eldest young son. It was evident to me that my very bright and articulate son was not like other boys of his age. He had an extraordinary level of concentration and extremely good reading skills and could converse at length with adults in a most unusual way, but he was also very anxious, fearful of noise and bright lights and unable to cope with anything unexpected in his day—the slightest change to the time we left the house, and all hell broke loose.
Once my son started his schooling, at the age of three, his young life and day-to-day experience became increasingly more challenging, and school life, which demands conformity, became something he was entirely unable to cope with. We struggled on for several years, because no one seemed to have any ideas; teachers said nothing except, occasionally, “Well, come and pick him up early if it gets too much”, “Is it all right if I call if he’s getting difficult in class?” or “Will it be all right if I don’t feed him with everyone else because it seems to be a problem in the canteen?”. I was just a mum with a little boy who seemed to have so many talents but could not cope with daily life.
Eventually, my GP, a wonderful man, referred us to a child psychologist in Newcastle, whose failure to correctly diagnose my son as autistic was nothing short of shocking. Not only did he fail to see what was becoming obvious to our family and our friends, who were trying to support us, but he tried to medicate my son with Ritalin, claiming that he suffered from attention deficit hyperactivity disorder—two behavioural traits entirely absent from my son’s behaviour. The doctor had failed to speak with my son’s teachers, having claimed that he had, before making his diagnosis, and it was only because I fought back against the medical profession’s failure that my son was not inappropriately drugged.
Thanks to huge financial support from my family, we eventually found a team of paediatric doctors based at Great Ormond Street hospital in London, 350 miles from our home in Northumberland, who quickly diagnosed my boy as an Asperger’s syndrome sufferer. We received support, understanding and guidance from these wonderful specialists who empowered us, James’s parents, to challenge school rules and regulations in order to get the changes to his learning environment so that he could once again enjoy and thrive in it. We have encountered two or three teachers for whom medals would be inadequate to recognise how they have put themselves out and learned themselves what it means to be an autistic little boy so that they can help other children coming through the system afterwards. As I say, medals will never be enough for them.
Without good friends, good luck and financial support, I know that our son would have fallen out of school by the time he was six or seven. The pressures that normal life put on our autistic children should not be underestimated. No right-thinking person would ask a child with a broken leg to run up the stairs, but the invisibility of autism means that these children are asked to do things that, given their hypersensitivities or gaps in neurological connectivity, simply ask too much of them.
Pauline Latham
My hon. Friend’s son was extremely lucky because he had a mum who was prepared to fight and had the ability to fight. There are many parents like her who will fight for their children, as most parents want to do. However, some parents do not have the ability or the confidence to do that, and these are the ones that are really being let down by the system.
Mrs Trevelyan
I absolutely agree with my hon. Friend. This is part of the reason I am here. I decided that advocacy was needed for those who are unable to access the system, who do not know how to fight back or who are too honest and quiet folk trying to get on with their day, muddling through it with difficult jobs and complex family environments. For such people it is too hard to fight what still today seems to be an implacable system in so many parts of our country.
The legislation of my right hon. Friend the Member for Chesham and Amersham—the Autism Act 2009—has begun to change attitudes towards autism, and I am now 10 years on from the battles I had to fight. The general population is becoming aware, slowly, of this invisible disability. The challenge is its invisibility—until it becomes visible through a crisis.
Many of our greatest artists and scientists have been on the spectrum—men and women who see the world differently from those of us who are “neuro-typical”, as my son always refers to me—mostly as an insult, I suspect, but I take it as it is! As a nation, we should value those who offer an understanding of our world that we neuro-typical folk simply do not have. They are vital to our growth as a nation, both culturally and economically.
The genius of the great Alan Turing brought us the computer—possibly the greatest leap since the steam engine—yet he was shunned and misunderstood throughout his life. We can read about his school years, which were truly awful. The damage that society inflicted on him through a lack of understanding and a blatant disregard for his difference in character highlights what we must reverse, 70 years on, to ensure that no child on the autistic spectrum is lost to us or our nation.
Small changes to the school environment and support for families that are bringing up autistic children with day-to-day tasks, which can reduce their stresses, can lead to positive and thriving outcomes for these wonderful members of our communities. Most importantly, we need a team of paediatric experts across every part of our country who can diagnose autistic children early on, and we need councils and schools that are trained and flexible in supporting these children to fulfilling lives.
I recently met a family in my constituency with three boys, two of whom have been diagnosed. I also have in Alan Carrick, at Northumberland County Council, a passionate advocate for all our special needs children, and he is particularly interested in supporting those on the autistic spectrum. It is difficult for him to meet the needs of each and every autistic child because there is not enough flexibility for him to provide preventive and creative solutions for individual families, which would provide practical support.
If we can reduce the day-to-day pressures on parents through low-cost early interventions, we will increase the chances of these families staying together. There are obvious long-term, value-for-money arguments for investing in these families early on to stop long-term costs to the state of family breakdown if we fail these children and their families at the early stage. I call on our Government to encourage our councils to be creative and forward thinking in their support for our autistic children—most urgently of all by getting speedy diagnosis so that support can hopefully follow.
Mr Robin Walker (Worcester) (Con)
It is a pleasure to follow the right hon. Member for North Norfolk (Norman Lamb), who made the point about the need for earlier diagnosis more powerfully than I possibly could; it is certainly one that I support in today’s motion. I also want to join in the many congratulations to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) and all those from both sides of the House who were involved in securing the Autism Act 2009. It was the beginning of a journey that continues with today’s debate.
I echo the concerns that were powerfully raised by the hon. Member for Argyll and Bute (Brendan O’Hara) and my hon. Friend the Member for Bury St Edmunds (Jo Churchill) about the risks of social isolation for people with autism, and I want to pay tribute to a couple of organisations in my constituency that have made great strides in reducing that isolation. The inspirational Monday Night Club was founded by Laura Gill, a constituent of mine with learning difficulties, and provides a forum for people with all sorts of learning difficulties, including a large number of people with autism, to come together, to socialise and to feel normal in a social setting.
Another organisation is ASPIE, the charity that I mentioned earlier, which was set up by Sarah Micklewright, an inspirational constituent who was on the autism spectrum. Tragically, and illustrating the point that my right hon. Friend the Member for Chesham and Amersham made about the lower life expectancy of people on the spectrum, she died two years ago next week aged only 38, but she has left a remarkable legacy in Worcester. A house was bought by her parents for people on the spectrum to come together, socialise and share ideas. I have been privileged to visit on several occasions and have been teased for my neurotypical behaviour and for my inaccurate birthday cake-cutting, among other things. It is a fantastic organisation that has played a part in not only helping to reduce the risk of social isolation, but inspiring people to come together and believe in themselves and in their capacity to work and to create businesses for people on the spectrum.
Many hon. Members have made powerful points about the talents of people on the spectrum and the need to unleash them, and we heard about the evidence in the article in The Economist. I pay tribute to the founders of an organisation called Wits End Wizardry, a web design company that was launched out of ASPIE in Worcester and entirely staffed by people on the autism spectrum. It discovered that the software programming skills of people on the spectrum are incredibly powerful and that with the right guidance and support and with the right people working with them to provide front-end customer service, they can deliver fantastic websites for all types of businesses and charities. I believe that it has done some important work for various organisations, including Ambitious about Autism, which shows the contribution that people on the spectrum can make.
Mrs Trevelyan
Does my hon. Friend agree that we need to use these great talents—this concentration and extraordinary ability to see the world in different ways? In the north-east, a business called Autism Works is taking on mathematical PhD autistic young men—they are all men—to challenge the big boys in the provision of that scientific and tech support. I think this is the future for our country.
Mr Walker
My hon. Friend is absolutely right about that, and I pay tribute to her for her fantastic speech earlier. She is on to something here; we are seeing this happening in the north-east and in the midlands, as our increasing cyber-security cluster is looking to take on more people with autism. We heard earlier about the incredible contribution of Bletchley Park, and many of the people who contributed to that work were probably on the spectrum. In cyber-security, businesses such as Titania in Worcester are actively going out to recruit people with autism. I want to see more businesses making that effort and creating opportunities for people. As Ambitious about Autism has shown, we need to do things differently. People cannot just be invited in for interview, because the whole process of interview is set up to work with neurotypical people. We need to create an autism-friendly job application process in order to make sure we are making the most of the talents of these people. I pay tribute to the businesses that are making the effort to do that.
I recently held a Disability Confident jobs fair in Worcester and I was very impressed to see Malvern Instruments, another major employer in our area, recruiting. One of the people representing it in its recruitment was somebody whom I had previously met at ASPIE and who is on the autism spectrum. I wish to pay tribute to Justin McKeon who will be running the Worcester 10k to raise funds for ASPIE, and if anyone in the Chamber wants to join me in supporting him after this debate, I would be delighted.
The Government have many programmes to help people to work. We are talking about halving the disability employment gap, and autism is a big area we should be hitting on to try to make sure that that happens. We also have the apprenticeships programme, many aspects of which can be tailored to support people with autism. I have spoken to my hon. Friend the Minister for Skills about this, and I know he answered a question about this during Education questions this week. I am delighted to hear that he is engaging in round-table meetings with the autism charities and organisations to make sure that we can tailor programmes within the apprenticeships programme to suit more people on the spectrum. There is much more work to be done on this and I would like this “A” badge I am wearing, with the “A” standing for apprenticeships, also to stand for ambition, aspiration and achievement for people with autism.